Sanctuary site relapse in chemotherapy-treated testicular cancer

The testis and central nervous system (CNS) may act as sanctuary sites for testicular germ cell tumours, as cytotoxic drugs penetrate these areas less well than systemic sites. We describe three patients who relapsed in the testis (one patient) or CNS (two patients) after receiving chemotherapy for responsive systemic disease. All three were asymptomatic at relapse, which was first manifest by rising tumour marker levels. These sanctuary site relapses were managed locally with surgery +/- radiotherapy. Two patients were rendered disease-free; one died of progression of his local disease only. Sanctuary site tumour should be considered when relapse occurs in the setting of otherwise chemosensitive disease; local therapy may be curative.