Pattern of relapse after first line treatment of advanced stage germ-cell tumors

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.

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.

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.

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.