This study evaluates the effect of combination chemotherapy on retroperitoneal metastases from nonseminomatous @entity2971 of the testis (NSGCTT). Sixty-six @entity1 with Stage III or bulky Stage II NSGCTT with clinically documented retroperitoneal metastases first received systemic chemotherapy. Seventeen @entity1 had minimal and 49 had advanced retroperitoneal metastases. The retroperitoneal metastases were classified as advanced if the @entity1 had a palpable retroperitoneal mass, ureteral deviation on intravenous pyelogram, or a mass with a diameter greater than or equal to 5 cm documented by a computerized axial tomographic scan, a pedal lymphangiogram, or surgery. The @entity1 with lesser but clinically evident retroperitoneal metastatic deposits were considered to have minimal retroperitoneal metastases. A complete remission of retroperitoneal metastatic deposits was achieved in 50 (76%) @entity1 , with chemotherapy alone in 25 (38%), and with combined chemotherapy and surgery in 25 (38%). The resected deposits consisted of mature @entity44 in 15 and malignant elements in 10. A complete remission using chemotherapy alone occurred in 13 of 17 (76%) with minimal and in 12/49 (24%) with advanced retroperitoneal metastases, and in 17/30 (57%) without and 8/36 (22%) with @entity44 in the @entity5 . The data strongly implied that the bulk of the metastatic deposits was a more important prognostic variable than the histology of the @entity5 . The adverse relationship of a teratomatous differentiation on the response rates with chemotherapy alone was offset by the success of supplemental surgery. This study suggests the benefit of a postchemotherapy retroperitoneal lymph node dissection (RPLND) in @entity1 with initially bulky retroperitoneal metastases (complete response [CR] increased from 24% to 67%; an additional 47% @entity1 had no evidence of disease). The @entity1 with minimal retroperitoneal metastases usually achieved a CR with chemotherapy alone. A routine RPLND after the chemotherapy is not indicated in @entity1 with initially minimal retroperitoneal metastases.

The role of chemotherapy and surgery in the treatment of retroperitoneal metastases in advanced nonseminomatous XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity5 :: ('MESH:D009369', 'Disease') :: ['testis tumor', 'primary tumor'] @entity44 :: ('MESH:D013724', 'Disease') :: ['teratoma'] @entity2971 :: ('MESH:D009373', 'Disease') :: ['germ cell tumors']
@entity5 :: (MESH:D009369,Disease) :: ['testis cancer']
