RESIDUAL MASSES IN RETROPERITONEUM AFTER CHEMOTHERAPY IN NONSEMINOMATOUS GERM CELL TUMOURS OF TESTIS - SINGLE INSTITUTIONAL STUDY - REVIEW OF 14 CASES.

Dr. Prabhat Nichkaode*, Dr. Shuddhattam Jain and Dr. Sachin Patel

ABSTRACT

Background: It is well recognized that Cisplatin based Chemotherapy is highly effective in metastatic testicular cancer. Non Seminomatous Germ Cell Tumours (NSGCT) & it’s metastasis are most chemosensative cancers. Most cancers become systemic when spread to Lymph nodes. There fore involved lymph node removal is not curative, because there are micro metastasis at distant places. The spread of testis cancer is different i.e.it is by & large more predictable and sequential. Hence surgical treatment of Residual masses in Retroperitoneum is curative in 35 to 75 % of patients. In this original article we want to present our study of fourteen cases of “Significant Residual disease “in Retroperitoneum and in two cases in Mediastinum, after Cisplatin based chemotherapy for NSGCTs by doing Retroperitoneal Lymph Node Dissection (RPLND) in all fourteen patients, along with Simultaneous Mediastinal Lymph node dissection ( MLND ) in one patient, and elective in one patient. With Primary Teratoma of Mediastinum along with Bilateral pulmonary metastitectomy. Aim: Aim of this manuscript is to review the role of RPLND in post chemotherapy patients in a single institutional study of 14 patients. Methods: This single institutional on going longitudinal study at tertiary care teaching institute started in 2009, since then we had 14 patients included in the study. Selection criteria was defined and the findings were recorded in prestructured prosoma. Results: We had 14 patients, all received Cisplatin based chemotherapy for high tumor burden in the retroperitoneum, marked by Imaging & Tumor Markers with no significant response, marked by reduction in size of masses in retroperitoneum, nor levels of Tumor markers. All patients belonging to the age between 18 to 27 years. Standard bilateral template RPLND done in all patients with one patient subjected for simultaneous RPLND & Mediastinal Lymph node dissection. There was no operative or Post operative mortality. Morbidity noted in terms of Post operative Prolonged Ileus, Lymphorroea through drain, and one patient had retrograde ejaculation. Conclusion: Post chemotherapy RPLND is definitely challenging as there is lot of Desmoplasia.. 9 out 14 patients are in follow up show no evidence of relapse of disease, 3 of them, were we could do nerve sparing RPLND are happy with the marriage life. Sperm banking was done only in three patients - have children. There was no mortality but morbidity is seen in postoperative period. Inclusion Criteria: Patients with diagnosis of NSGCT treated with Platinum based Chemotherapy. Who recovered completely from effects of Chemotherapy in terms of WBC, Platelets, LFT, PFT, KFT, No extra pulmonary Metastasis. Post chemotherapy significant residual masses in retroperitoneum as on Imaging compared to pre chemotherapy tumor load, with high levels of tumor markers. Patients who are willing to enroll in this study Exclusion Criteria: Patients with evidence of Extra Pulmonary Metastasis, Patients with Poor Lung function after Bleomycin based chemotherapy. Not willing to enroll in this study.

Keywords: NSGCT, Cis-Platinum -Chemotherapy, Residual Masses Tumor markers, CT Scan, RPLND.