Management of the post chemotherapy subcentimeter residual mass: the case for observation

Excerpt

With the introduction of cisplatin-based chemotherapy, testis cancer has now become a highly curable disease. For patients presenting with good risk disease, the primary goal for physicians is to decrease the treatment-related morbidity without compromising cure. For low-volume (<5 cm) stage II disease, the treatment options include chemotherapy or primary RPLND (in those with normal serum tumor markers). For higher volume (>5 cm) stages II and III disease, initial treatment is typically systemic chemotherapy. Following the systemic chemotherapy, patients achieving a partial radiographic response (PR) generally undergo post chemotherapy (PC) surgery as 50–60% harbor either teratoma or active cancer. Thus, patients achieving a PR require dual therapy: chemotherapy plus surgery. …