Evaluation of radiotherapy and/or surgicopathological staging after chemotherapy in the management of metastatic germ cell tumours.

Thirty of 83 patients with metastatic germ cell tumours undergoing cytotoxic chemotherapy have required post-treatment surgicopathological staging and in ten of these, viable malignancy was detected. In 8, cystic mature teratoma was excised. Though this surgery can be extremely difficult and in 12 of the 30 cases necrotic tissue only was excised, the toxicity and distress of continuing unnecessary chemotherapy for the patients with necrotic tissue or mature teratoma, and the chance to cure patients with persistent malignant disease with second-line chemotherapy, mean that the early use of this surgery will continue to be an extremely important element in the management of patients with malignant teratoma. However, for patients with metastatic pure seminoma, given the difficulty of removing residual necrotic tissue because of dense fibrous tissue and the exquisite sensitivity to single agent cisplatinum therapy demonstrated in this paper, it is preferable to delay surgery until post-treatment regression has ceased.