title: Benefit and costs of follow-up programs in nonseminomatous germ cell tumors of the stages IIb-IV: the Munich experience.
abstract: Since 1979 we have seen 197 patients with nonseminomatous germ cell tumors (NSGCT) of the stages IIb-IV. 185 of these are evaluable (3 lost to follow-up, 9 still in treatment). The majority of the patients was given platinum-vinblastine-bleomycin treatment (PVB). 138/185 (74.6%) have achieved a first complete remission (CR), and 131/185 (70.8%) are currently found with no evidence of disease (NED). All patients in CR have been followed by physical examinations, blood chemistry including tumor markers, and chest X ray (years 1 and 2: 8 times; year 3: twice; years 4 and 5: twice) and by abdominal computer tomography (CT; years 1 and 2: 6 times; year 3: twice; years 4 and 5: twice). So far this follow-up procedure has been performed for a total of 326 patient years costing approximately $215,000. 18/138 patients (13%) were found in the first relapse. 13/18 could achieve a 2nd CR under salvage therapy. 2 of these patients were found in a 2nd relapse and 1 of these was brought into a third CR. 1 patient died in CR from reasons unrelated to NSGCT. The 20 first and second relapses were detected with clinical symptoms (6 times), chest X ray (6 times), abdominal CT (5 times), and tumor marker elevation (3 times). This represents 14 relapses detected by follow-up examinations without clinical symptoms. Only 1/6 patients complaining of clinical symptoms as a first sign of the 1st recurrence achieved a second CR, and 5/6 died of progressive disease, whereas all 12 patients with first relapses detected without clinical symptoms during follow-up could be brought into second CR. Although this is a retrospective analysis and 3/6 patients with symptomatic relapses had additional brain lesions, these data, with due caution, tend to argue in favor of close follow-up programs with monitoring additional to physical examination for patients with NSGCT in CR. Furthermore, 15/18 first relapses (83%) were found within the first 2 years and 3/18 later. Since all 3 patients detected with a late recurrence achieved a second CR, at least 5 years of follow-up seem justified.
authors.affiliation: Klinikum rechts der Isar, Technical University, Munich, FRG.
authors.forename: W E
authors.initials: WE
authors.lastname: Berdel
authors.forename: C
authors.initials: C
authors.lastname: Clemm
authors.forename: R
authors.initials: R
authors.lastname: Hartenstein
authors.forename: J
authors.initials: J
authors.lastname: Nisenbaum
authors.forename: U
authors.initials: U
authors.lastname: Fink
authors.forename: J
authors.initials: J
authors.lastname: Rastetter
authors.forename: W
authors.initials: W
authors.lastname: Wilmanns
mesh_terms: D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed