Patients with bulky seminoma at any site frequently have residua] roentgenographic abnormalities after chemotherapy. Management of such patients with residual mass after primary chemotherapy treatment of seminoma remains controversial. Previous experience at Indiana University and the Southeastern Cancer Study Group as well as other institutions suggest that the residual mass is commonly a dense scirrhous reaction in 85 to 90 percent of cases and viable seminoma or unexpected teratoma is only rarely encountered. In addition, surgery in such patients is difficult and frequently incomplete. buy birth control online
Investigators at Memorial Sloan Kettering Cancer Center have reported finding viable seminoma in five of 20 patients with pure seminoma undergoing postchemotherapy resection of residual roentgenographic abnormalities. In all cases of residual viable seminoma, the mass was greater than or equal to 3 cm. At Memorial, patients with seminoma and a greater than 3 cm residual mass after cisplatin-based chemotherapy are felt to be at high risk of harboring viable tumor. In such patients, resection is recommended to ascertain the nature of the residual mass and need for subsequent treatment. Other centers including Indiana University recommend close observation without surgery.
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