Late relapse of nonseminomatous germ cell tumours

Late relapses of nonseminomatous cell tumours (NSGCTs) are rare and occur by definition at > or =2 years after successful treatment. They represent a major challenge of current treatment and follow-up of the affected patients. We present relevant literature on late-relapsing NSGCTs to provide an overview over the effect of primary treatment, patient and tumour characteristics. Of all patients with NSGCT, 1-6% have a late relapse, with those having extragonadal GCTs being at greatest risk. The predominant site of relapse is the retroperitoneal space. Suboptimal primary treatment, especially insufficient retroperitoneal surgery, increases the risk of late relapses. Radical surgery is probably the most important treatment, with advances in salvage chemotherapy adding to the improved cure rates. Treatment at an experienced institution ensures a 5-year cancer-specific survival of >50%, and this approaches 100% in case of single-site mature teratoma. Diagnosis and proper treatment of patients with late-relapsing NSGCTs is challenging and should be restricted to experienced centres only. Referral of late-relapsing patients to high-volume institutions ensures the best chances of cure and enables increasing understanding of tumour biology and the clinical course of these patients.