Bleomycin-Related Toxicity and Operative Morbidity After Postchemotherapy Retroperitoneal Lymph Node Dissection in Germ Cell Tumors


Key Points

  • Use of bleomycin was associated with shorter use of supplemental oxygen, shorter operative time, and reduced estimated blood loss.
  • BEP patients had reduced hospital stay.

In a retrospective single-institution analysis reported in the Journal of Clinical Oncology, Calaway et al found that the addition of bleomycin to etoposide/cisplatin did not appear to increase risk of pulmonary or postoperative morbidity after postchemotherapy retroperitoneal lymph node dissection in men with International Germ Cell Cancer Collaborative Group (IGCCCG) good-risk germ cell tumors. 

Three cycles of bleomycin, etoposide, and cisplatin (BEP × 3) or four cycles of etoposide and cisplatin (EP × 4) are considered first-line regimens for men with good-risk germ cell tumors. Analysis of the prospectively maintained Indiana University Testis Database identified 234 good-risk patients treated between 2006 and 2016 who received BEP × 3 (n = 191) or EP × 4 (n = 43) as induction chemotherapy, had residual retroperitoneal mass > 1 cm, and had normal preoperative serum tumor markers.

The primary outcomes of interest were pulmonary morbidity (prolonged intubation, reintubation, supplemental oxygen use, intensive care unit [ICU] stay) and operative morbidity (operative time, length of stay, concomitant procedures, estimated blood loss).

Treatment Outcomes

All patients were extubated immediately after surgery, with none requiring reintubation or discharge on oxygen. Two patients in each group required ICU stay for nonpulmonary reasons. No significant differences between groups were found for preoperative mass size (P = .42) or concomitant surgeries (P = .58).

Patients receiving BEP had shorter use of supplemental oxygen (0.99 vs 1.63 days, P = .005), shorter operative time (131 vs 170 minutes, P < .01), and reduced estimated blood loss (194 vs 226 mL, P < .01). The length of hospital stay was reduced in patients receiving BEP (3.3 vs 3.9 days, P < .01).

The investigators concluded, “In a modern surgical cohort, the inclusion of bleomycin does not seem to influence pulmonary morbidity, operative difficulty, or nonpulmonary postoperative complications after [postchemotherapy retroperitoneal lymph node dissection] in men with IGCCCG good-risk [germ cell tumors].”

Adam C. Calaway, MD, of the Department of Urology, Indiana University School of Medicine, is the corresponding author for the Journal of Clinical Oncology article.

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