Late relapse in testicular germ cell tumors.
OBJECTIVE
Analysis of patients with late relapse of testicular germ cell tumors (GCTs) with reports on clinicopathological features and outcomes.


METHODS
We identified all patients diagnosed with testicular GCTs at our Institute between 1988 and 2004 who developed relapse > or = 24 months after completion of primary therapy. A retrospective case-note review was performed to extract clinical, pathological, treatment and outcome data.


RESULTS
Six patients (1.25%) developed late relapse. All patients presented with stage I disease and were classified as "good risk" according to the International Germ Cell Consensus Classification. Mean time to late relapse was 48 months. Markers at late relapse were normal in all patients. Relapse was confined to retroperitoneal sites in five patients and located in the mediastinum in one patient. Five patients were managed by chemotherapy alone while one underwent combined treatment with surgery followed by chemotherapy. All patients obtained a complete response and all remained free from recurrence with a mean follow-up of 115 months.


CONCLUSIONS
The incidence of late relapse in this small series is low. Chemonaive patients with late relapse were successfully salvaged with chemotherapy alone or surgical excision followed by cisplatin-based chemotherapy. The optimal duration of follow-up in patients with testicular GCTs is not known and practice varies widely. At our Institute we advise lifelong follow-up of all patients with malignant GCTs of the testis.
Institute of Radiotherapy, University of Florence, Florence, Italy. beatrice.detti@googlemail.com
Beatrice
B
Detti
Lorenzo
L
Livi
Silvia
S
Scoccianti
Icro
I
Meattini
Mauro
M
Gacci
Alberto
A
Lapini
Giampaolo
G
Biti
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D008499:Medical Records; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D017063:Outcome Assessment, Health Care; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D012189:Retrospective Studies; D018243:Teratocarcinoma / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery