Successful 2-year-long remission following repeated salvage surgery in a patient with chemotherapy-resistant metastatic nonseminomatous germ cell tumor.

A 34 year-old man with a diagnosis of nonseminomatous testicular cancer with retroperitoneal lymph node metastasis (T1N3M0S2, stage IIIb; intermediate prognosis, made after right inguinal orchiectomy was performed) was referred to our hospital after having had a total of eight courses of systemic chemotherapy and external-beam radiotherapy to the retroperitoneal region in the previous 1 year. His serum alpha-fetoprotein (AFP) level remained elevated. Two courses of paclitaxel, etoposide, and cisplatin combined chemotherapy (TEP; paclitaxel 120 mg/m(2) day 1, etoposide 80 mg/m(2) days 2-5, cisplatin 20 mg/m(2) days 2-5) failed to normalize the AFP level. During the following 2 years he underwent salvage surgery four times; infrarenal retroperitoneal lymph node dissection (RPLND), left neck lymph node dissection, thoracic duct excision, and suprarenal RPLND. Viable cancer cells were found in all surgically resected specimens, except for the neck lymph node specimen. The serum AFP level was normalized and he has been well without relapse for 2 years after the last surgery. The present case suggests that repeated salvage surgery may be beneficial in selected patients with a chemotherapy-resistant metastatic germ cell tumor.