Late recurrences of germ cell malignancies: a population-based experience over three decades

Abstract

The purpose of this study was to explore the incidence of late relapse in patients with malignant germ cell tumour (MGCT) in a population-based series, with emphasis on the mode of detection, survival, and the relevance of histological findings. The clinical records from a population-based cohort of patients with seminoma (n ¼ 1123) or non-seminoma (n ¼ 826) were evaluated for late relapses. Twenty-five patients developed a late relapse. The cumulative 10-year incidence rate was 1.3%. All 10 seminoma patients, but only eight of 15 non-seminoma patients relapsed with vital malignant tumour (P ¼ 0.02). Teratoma or necrosis was found in seven of nine primarily chemotherapy-treated non-seminoma patients with normal tumour markers at late relapse. Six of nine patients operated with limited retroperitoneal lymph node dissection as part of the primary treatment had relapsed retroperitoneally outside the original operation field. The 10-year cause-specific survival was 68% in all patients, 50% in patients relapsing with vital malignant tumour and 100% in those with teratoma/ necrosis before or after salvage chemotherapy. The 10-year incidence rate of late relapses of 1.3% might reflect the true incidence rate in a population-based cohort of MGCT patients, with cure in at least half of them.

Radiation-induced sarcoma: 25-year experience from The Norwegian Radium Hospital

“…Sarcomatous foci may occur within the primary tumour in testicular germ cell tumours and not at least in late recurrences, which may be misclassified as RIS [22]. This possibility has to be excluded by extensive revision of the primary tumour, as done in our study.…”

Evidence‐based guidelines for following stage 1 seminoma

“…In a population-based study of >1100 patients with seminoma, the incidence of such late failure was <0.5%. 28 Although some patients will relapse beyond our recommended time of follow-up cessation, ongoing routine imaging of all patients to detect very small numbers of relapses is of doubtful value. Of the current management strategies, there is a relatively short experience with the use of carboplatin in prospective trials.…”

Late relapse in stage I of nonseminomatous germ cell testicular cancer on surveillance

“…In view of these data it is debatable, if regular followup of all testicular cancer patients beyond 5 years is a good use of medical resources. Most patients with VLR are diagnosed due to symptoms, however in up to 50 %, elevated STM can be found in both seminomas and NSGCTT (1,6). Patient education about relapse symptoms and physician awareness is a very important part of survivorship management.…”

“…In 2-4 % of patients, relapse may occur later (2). Most investigators defi ne LR as recurrence at least 2 years after completion of successful primary treatment and differentiate between those occurring before and after 5 years (VLR) (3,4,5,6). Primary aim of the present study was to assess the incidence and clinical outcome of chemotherapy-naïve patients with LR in a cohort of CS-I patients undergoing surveillance.…”