[The Munich follow-up program in advanced non-seminoma testicular tumors. Benefits and costs]

Results in 185 of 197 patients with non-seminomatous testicular tumours treated since 1979 were retrospectively analysed. Most of them had been given chemotherapy according to the PVB schedule. In 138 patients (75%) a first complete remission was achieved, and 131 (71%) are currently disease-free. All patients in complete remission were entered in a follow-up programme consisting of physical examination, laboratory tests including tumour markers, chest X-ray and abdominal CT. A total of 326 patient-years of follow-up has so far been carried out at a cost of DM 650,000. A first relapse was detected in 18 patients (13%); 13 of them reached a second remission after further treatment. The 20 first and second relapses were detected by clinical symptoms (n = 6), chest X-ray (n = 6), abdominal CT (n = 5), or a rise in tumour markers (n = 3). Only one of six patients in whom clinical symptoms were the initial evidence of a first relapse, obtained a second complete remission. The five others in this group died of progressive disease. In contrast, all the twelve patients whose first relapses were detected by follow-up investigations in the absence of clinical symptoms, obtained second complete remission. 15 of the 18 first relapses were detected within the first two years. All three patients with late relapses were brought into second complete remissions. On this evidence, follow-up for at least five years appears justified.