Liver metastases in germ cell tumors.

Authors

null

Suliman Boulos

Addenbrookes Cambridge University Hospital, Cambridge, United Kingdom

Suliman Boulos , Jonathan Shamash , Han Hsi Wong , Sarah Maria Rudman , Gary Doherty , Wendy Ansell , Daniel Berney , Marika Reinius , Peter Wilson , Linda Shephard , Danish Mazhar

Organizations

Addenbrookes Cambridge University Hospital, Cambridge, United Kingdom, St Bartholemew's Hospital, London, United Kingdom, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom, Guy's Hospital, London, United Kingdom, University of Cambridge, Cambridge, United Kingdom, St Bartholomew's Hospital, London, United Kingdom, St. Bartholomew's Hospital, London, United Kingdom, Guy's and St. Thomas' University Hospital, London, United Kingdom, Addenbrooke's Hospital, Cambridge, United Kingdom

Research Funding

Other

Background: Metastatic germ cell tumour (GCT) to the liver is considered rare and usually caries adverse outcomes. We aimed to determine the outcome of patients with metastatic GCT to the liver. Methods: We identified retrospectively 36 patients with metastatic germ cell tumour to the liver between the years 2001 and 2015, from which 34 were non-seminomatous germ cell tumours (NSGCT) and two seminomas. 35 patients had other sites of metastases including lungs, bones and brain. Elevated tumour markers were seen in the vast majority of patients (97.2%). 15 patients received treatment with dose intense regime including actinomycin-D, high-dose methotrexate, etoposide and cisplatin (GAMEC) every 14 days, 20 patients received the standard protocol of bleomycin, etoposide and cisplatin (BEP) every 21 days and one patient received POMB/ACE chemotherapy. 20 patients had an induction cycle of cisplatin, vincristine and bleomycin (Baby-BOP) prior to initial treatment. Results: 12 patients had radiological complete response (CR) and 19 patients had radiological partial response (PR) in the liver, with five patients having a CR in all sites with negative markers. Five patients underwent liver resection with no viable tumour seen. Three patients that underwent liver resection also had retroperitoneal lymph node dissection (RPLND) the histology from which was viable seminoma in one case, mature teratoma in one case and necrosis in the final patient.16 patients had marker negative PR, 10 patients had marker positive PR and 5 patients had a marker negative CR. 15 patients eventually relapsed and 10 died with only one liver relapse. Median Overall survival for patients that received BEP was 35.38 months (not reached for GAMEC) (p = 0.0147). The median progression free survival (PFS) for the BEP group was 24.45 months (not reached for GAMEC) (p = 0.22) and the 2-years PFS for the GAMEC and BEP groups were 73% and 55% respectively. Conclusions: Within this cohort, liver metastasis from germ-cell tumour had a good response to chemotherapy, with progression occurring mainly in extra-hepatic sites. There was also a suggestion that dose dense GAMEC regime may offer superior efficacy compared with BEP.These results also question the role of liver metastectomy after initial response to chemotherapy.

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Abstract Details

Meeting

2017 Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Penile, Urethral, and Testicular Cancers; Renal Cell Cancer

Track

Renal Cell Cancer,Penile, Urethral, and Testicular Cancers

Sub Track

Penile, Urethral, and Testicular Cancers

Citation

J Clin Oncol 35, 2017 (suppl 6S; abstract 403)

DOI

10.1200/JCO.2017.35.6_suppl.403

Abstract #

403

Poster Bd #

B20

Abstract Disclosures