title: Pattern of relapse after first line treatment of advanced stage germ-cell tumors.
abstract: OBJECTIVE
  We performed a retrospective analysis of first relapses after cisplatin-based chemotherapy in patients with advanced germ-cell tumors, in order to better define the appropriate follow-up.
  
  
  METHODS
  These patients were treated between 1986 and 1998 in two institutions. They were either followed after first-line chemotherapy at the same center or referred for relapse.
  
  
  RESULTS
  Ninety-six patients relapsed (17.5% of the total number of patients treated in the same time period). Thirty-five (36.4%) patients had serum tumor marker levels (AFP, hCG and LDH) normal values. Sites of relapse were: abdominal in 47 (49%) patients, thoracic in 17 (17.7%), thoraco-abdominal in 15 (15.6%), and brain in 8 (8.3). Seven (7.3%) patients had elevated markers only, 1 (1%) had isolated supra-clavicular lymph node, 1 (1%) had bone metastasis only. Eighty-two patients (85%) relapsed during the first 18 months of follow-up. All patients with brain metastases at relapse and those who obtained sCR after chemotherapy relapsed within 8 months of follow-up. Sixteen patients underwent resection of growing teratoma.
  
  
  CONCLUSIONS
  These results allow to recommend extensive follow-up during the first two years after response to first line treatment. It includes marker level determination and whole body CT scan and less intensive work-up there after.
authors.affiliation: Department of Medical Oncology, Centre Léon Bérard, Lyon, France. flechno@lyon.fnclcc.fr
authors.forename: A
authors.initials: A
authors.lastname: Fléchon
authors.forename: S
authors.initials: S
authors.lastname: Culine
authors.forename: C
authors.initials: C
authors.lastname: Théodore
authors.forename: J-P
authors.initials: JP
authors.lastname: Droz
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D001707:Biopsy, Needle; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000627:therapeutic use; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods
chemical_list: D014408:Biomarkers, Tumor; D002945:Cisplatin