Retroperitoneal lymph node dissection and pathologic staging for lowvolume stage II nonseminoma

The American Joint Committee on Cancer and the Union Internationale Contre le Cancer revised the tumor, nodes, metastasis (TNM) classification of testicular GCT to include serum concentrations of a-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase into staging of advanced disease. Findings of vascular or lymphatic invasion were incorporated in the staging of the primary testicular tumor, and the pathologic staging for stage II disease was modified [1].

RPLND is used as the primary curative treatment for selected patients who have clinical stage I and stage II disease. A recent retrospective analysis by Stephenson and colleagues [12] demonstrated that primary RPLND in selected patients can circumvent the toxicity associated with chemotherapy by excluding patients who have elevated serum tumor markers and clinical stage lib disease or greater, thus minimizing chemotherapy toxicity for the other carefully selected patients. For others who have more advanced disease, adjuvant chemotherapy is indicated to maintain the high rate of cure. At RPLND, pathologic TNM staging is assessed based on four staging groups (Table 1), and treatment is planned according to staging. For example, because 90% or more of patients who have pN0 disease usually experience a disease-free survival with surgery alone, adjuvant chemotherapy is not offered to these patients [13,14].

0 0

Post a comment