Thoracic Metastasectomy of Residual Germ Cell Tumor Metastases After Sequential High-Dose Chemotherapy with Autologous Stem Cell Transplantation in Relapsed Patients

S. Sponholz¹, G. Karaindros¹, K. Chalepaki Ntelli¹, M. Schirren², P. Albers³, A. Lorch⁴, T. Walles⁵, A. Fisseler-Eckhoff⁶, J. Schirren^1
1Thoracic Surgery Agaplesion Markus Hospital, Frankfurt, Hessen ²Thoracic Surgery Klinikum rechts der Isar, München, Bayern ³Department of Urology Heinrich-Heine-University, Duesseldorf, Nordrhein-Westfalen ⁴Department of Medical Oncology University Hospital Zurich, Zurich, Zurich ⁵Thoracic Surgery Otto-von-Guericke University of Magdeburg, Magedeburg, Sachsen-Anhalt ⁶Department of Pathology Horst-Schmidt-Klinik Wiesbaden, Wiesbaden, Hessen

Purpose: Due to very few studies with small case numbers, the pathological and patient outcomes after resection of residual thoracic metastases of germ cell tumors after sequential high-dose chemotherapy with autologous stem cell transplantation (HDC+SC) are unclear.

Methods: We analyzed the outcomes of our patients who were resected for residual germ cell tumor metastases after HDC+SC between 1999-2017. Patients and tumor characteristics as well as short-term outcomes were analyzed by descriptive statistics. Long-term outcomes and survival curves were analyzed using the Kaplan-Meier method.

Results: In total, 84 patients with a median age of 34.5 years (18-61 years) were included. In the HDC+SC setting 89.3% of the patients had lung metastases, 25.0% had mediastinal metastases, 8.3% had retrocrural metastases and 7.1% had cervical metastases. Of the patients with lung metastases, 70.9% had bilateral disease. In four patients, the opposite side could not be operated on in the event of progression; they died after 4, 6,11 and 23 months.

Further treated metastases in the HDC+SC setting were located in the retroperitoneum (33.3%), in the liver (8.3%), in the brain (21.4%) and in the bones (4.8%).

Regarding postoperative histologies after thoracic resection, 50.0% showed necrosis, followed by teratoma (27.4%), and viable cancer (22.6%). Two patients with viable cancer had a cancer transformation. The minor and major morbidity rates were 4.8% and 10.7%, respectively and the 90-day mortality rate was 0.97%. Median follow-up time was 127 months (1-299 months) and 5- and 15-year overall survival rates were 77% and 71%, respectively.

Conclusion: Even after sequential high-dose chemotherapy with autologous stem cell transplantation and partly high tumor burden, thoracic residual tumor resection can be performed with low morbidity and good long-term survival. The fact that only about half of the histologies are complete necroses after high-dose chemotherapy emphasizes the importance of complete resection.

Identify the source of the funding for this research project: None