How do you approach a metastatic mixed non-seminoma germ cell tumor s/p orchiectomy and chemotherapy with normalization of tumor markers and persistent multiple lung metastasis (>1 cm) that cannot be fully resected?

The first question I would ask is, does he have residual radiographic abnormalities in the retroperitoneum? If he does and it hasn't been done yet, I would go to a proper post-chemotherapy RPLND as the first step. The second question is whether we should perform any biopsy of the lung nodules to pat...