ecancermedicalscience

Review

Role of chemotherapy prior to orchiectomy in metastatic testicular cancer—is testis really a sanctuary site?

27 Feb 2014
B Vinusha Reddy, A Sivakanth, G Naveen Babu, Krishnamurthy Swamyvelu, YG Basavana Goud, BA Madhusudhana, Vasu Reddy Challa

A germ-cell tumour (GCT) of the testis is a chemosensitive tumour with high cure rates even in advanced disease. Radical inguinal orchiectomy is the initial procedure used to diagnose it which helps to risk-stratify these patients. However, in patients with life-threatening metastases, primary chemotherapy was attempted in a few studies, followed by delayed orchiectomy. The aim of this review is to study the histopathological findings of delayed orchiectomy and the retroperitoneal lymph node dissection (RPLND) specimens, to assess difference and concordance in response rates in histological types of GCTs in pathological specimens. Overall, 352 patients received initial chemotherapy followed by orchiectomy, and 235 of them had undergone RPLND. Delayed orchiectomy specimens had viable tumour in 74 (21%) patients, scarring/necrosis in 171 patients (48.5%), and teratoma in 107 (30.3%) patients. RPLND specimens had residual disease in 36 (15.3%) patients, scarring/necrosis in 100 patients (42.5%), and teratoma in 99 patients (42.3%). Patients with seminoma who underwent delayed orchiectomy had complete disappearance of tumour in 81.3% of cases, and in non-seminomatous GCT, it was 43.4%. These results raise the question of the existence of a blood–testis barrier in patients with advanced GCT and argue against the testis as a sanctuary site.

Related Articles

Adewale Isaiah Oyewole, Funmilola Olanike Wuraola, Amir H Sohail, Titilope Ogunniyi, Chinyere Nwankwo, Zainab Oyindamola Adegbite, Dorcas Olaide Ebekue, Clement D Awe, Elizabeth N Christian, Kristina Diaz, Oluwasegun Afolaranmi, Clara N Lambert, Dan Sherman, George Gutierrez, Chinenye Iwuji, Juliet S Lumati
Ally H Mwanga, Jeanine Justiniano, Eric M Mbuguje, Balowa Musa, Deogratius B Mwanakulya, Andrew Swallow, Edith Kimambo, Eva Uiso, Swaleh Pazi, Latifa Rajab, Nashivai E Kivuyo, Larry Akoko, Azza Naif, Advera Ngaiza, Sara Nyagabona, Jerry Ndumbalo, Amos R Mwakigonja, Jim E Littlejohn, Seif Wibonela, Cameron E Gaskill
Rodrigo Lastra, Patricia Iranzo, Javier-David Benítez-Fuentes, Ana Callejo, Mara Cruellas, Jacobo Gómez Ulla, Isabel Pimentel, José Luis Pérez-Gracia, Marta Ramos, Francisco Gil Moncayo, María Álvarez Alejandro, Marta Gascón, Sergio Martínez Recio, Pilar Rivero, Jorge Bartolomé, Antonio David Lázaro Sánchez, David Fernández Garay, Alicia de Luna Aguilar, Isabel Lorenzo Lorenzo, Joan Brunet, Noemi Reguart, Dario Trapani
Clara Pierini, Clara Mariano y Jelicich, Fabiola Bascuñán Acuña, María De San Martín, Aldana Casati, Cecilia Casullo, Marta Díaz Madero, Delfina Grennon Viel, Estefania Marzik, Gabriela Rodriguez, Victoria Viel Temperley