title: A single-centre observational study of surgery and late malignant events after chemotherapy for germ cell cancer.
abstract: OBJECTIVE
  To review the impact of surgical staging after treatment on the late malignant events in an unselected group of patients treated with chemotherapy for germ cell cancer of the testis over the last 16 years.
  
  
  METHODS
  The study comprised 256 patients treated between 1978 and 1994 who were reviewed for late relapse and development of second germ cell and non-germ cell cancer.
  
  
  RESULTS
  At diagnosis, 142 patients had clinical stage 2, 30 stage 3 and 84 stage 4 disease; 57 patients relapsed within 20 months of treatment, while late germ-cell cancer relapses (> or = 24 months after treatment) occurred in six patients. Of patients relapsing early or late, 42% and 33%, respectively, received surgery after treatment. Only two of those relapsing late remain progression-free with further treatment. Four patients developed germ cell cancer in the contralateral testis, while six developed second non-germ cell cancers.
  
  
  CONCLUSIONS
  Late events occurred in 6.2% of 256 patients in this series, from 29 to 141 months after treatment. Given that the late relapse rate of six of 256 (2.3%) is less than the incidence of mature teratoma at routine retroperitoneal lymph node dissection, more patients may eventually relapse. These results suggest that there might be a case to evaluate the use of ultrasonographic surveillance of the retroperitoneum and testis at 5, 10 and 20 years, in addition to extending routine surveillance.
authors.affiliation: St Bartholomew's Hospital School of Medicine and Dentistry, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Ravi
authors.forename: R T
authors.initials: RT
authors.lastname: Oliver
authors.forename: J
authors.initials: J
authors.lastname: Ong
authors.forename: D F
authors.initials: DF
authors.lastname: Badenoch
authors.forename: C G
authors.initials: CG
authors.lastname: Fowler
authors.forename: A M
authors.initials: AM
authors.lastname: Paris
authors.forename: W F
authors.initials: WF
authors.lastname: Hendry
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018237:Germinoma / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D016609:Neoplasms, Second Primary / Q000453:epidemiology; D012189:Retrospective Studies; D018239:Seminoma / Q000188:drug therapy* / Q000601:surgery; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents