title: Patterns of relapse after chemotherapy in patients with high-risk non-seminomatous germ cell tumor.
abstract: OBJECTIVE
  We investigated the pattern of relapse after chemotherapy in patients with high-risk germ cell tumor (GCT) to critically review common follow-up procedures including close monitoring of serum tumor markers and radiologic procedures.
  
  
  METHODS
  645 patients received first-line (434 patients) or salvage platinum-based (211 patients) high-dose chemotherapy in three multicenter trials. Retrospective analysis comprised 77 patients after first-line and 61 after salvage chemotherapy, who had achieved at least a partial remission but progressed afterwards.
  
  
  RESULTS
  At relapse, 24% of the patients presented with an isolated elevation in serum tumor markers, 26% with pathologic radiologic confirmation with negative tumor markers, and 42% with elevated tumor markers and radiologically confirmed progression. Relapse was detected by clinical symptoms in 8%. 46% relapsed within 3 months and 97% within 2 years. Relapse pattern did not correlate with tumor marker status or metastasis location prior to chemotherapy, line of chemotherapy, response status after chemotherapy or time point of relapse.
  
  
  CONCLUSIONS
  In high-risk GCT patients, relapse after chemotherapy is detected either by tumor marker elevation alone, radiologic imaging alone or both, in one third each. Close monitoring including serum tumor markers, radiologic imaging and clinical examination appears warranted within the first 2 years.
authors.affiliation: Department of Oncology/Hematology/Bone Marrow Transplantation/Pneumology, University Cancer Center Hamburg-Eppendorf, Martinistrasse 52, DE-20246 Hamburg, Germany. k.oechsle@uke.uni-hamburg.de
authors.forename: Karin
authors.initials: K
authors.lastname: Oechsle
authors.forename: Anja
authors.initials: A
authors.lastname: Lorch
authors.forename: Friedemann
authors.initials: F
authors.lastname: Honecker
authors.forename: Christian
authors.initials: C
authors.lastname: Kollmannsberger
authors.forename: Jörg T
authors.initials: JT
authors.lastname: Hartmann
authors.forename: Ina
authors.initials: I
authors.lastname: Boehlke
authors.forename: Jörg
authors.initials: J
authors.lastname: Beyer
authors.forename: Carsten
authors.initials: C
authors.lastname: Bokemeyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood*; D002945:Cisplatin / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000188:drug therapy; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis* / Q000188:drug therapy / Q000556:secondary; D017671:Platinum Compounds; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D017671:Platinum Compounds; D002945:Cisplatin