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Late relapse of germ cell tumors after cisplatin-based chemotherapy.
- Source :
-
Annals of oncology : official journal of the European Society for Medical Oncology [Ann Oncol] 1997 Jan; Vol. 8 (1), pp. 41-7. - Publication Year :
- 1997
-
Abstract
- Background: Sparse data are available with regard to the incidence, clinical characteristics, therapeutic management and prognosis of male patients with germ cell tumors, who relapse more than two years after completion of cisplatin-based chemotherapy.<br />Patients and Methods: A review of 530 patients treated at two institutions from 1978 to April 1994 was conducted. Twenty-five cases of late relapse were identified. Cumulative risk of late relapse was calculated according to the Kaplan-Meier method.<br />Results: 418 of 523 patients (80%) who received their first-line treatment at our institutions were relapse-free at two years. Among these 418 patients 18 cases (4.3%) developed a late relapse. The cumulative risk of late relapse was 1.1% at five years and 4.0% at ten years excluding patients with prior early relapses who carried risks of 9.4% and 29%, respectively (P < 0.0001). No case of late relapse was observed among patients receiving adjuvant chemotherapy. The risk of late relapse was lower in patients with good-risk non-seminomatous germ cell tumors than in poor-risk patients according to Medical Research Council criteria (P < 0.01). Seven further patients were referred from other institutions for treatment of late relapse. At a median follow-up of 38 months (range, 3 to 121) after treatment of late relapse 9 of 25 patients (36%) are continuously disease-free. Six of these nine patients had surgical resection of carcinoma or teratoma as a component of their therapy.<br />Conclusion: The incidence of late relapse after cisplatin-based chemotherapy of germ cell tumors is related to initial tumor burden and is somewhat higher than previously expected. Chemotherapy seems to have only minor curative potential, but localized resectable disease can be cured by surgery. Annual follow-up evaluations allow to detect the majority of late relapses at an asymptomatic stage and should be extended throughout the patient's life.
- Subjects :
- Adult
Biomarkers, Tumor analysis
Bleomycin administration & dosage
Carcinoma, Embryonal drug therapy
Carcinoma, Embryonal secondary
Carcinoma, Embryonal surgery
Chemotherapy, Adjuvant
Cisplatin administration & dosage
Combined Modality Therapy
Cyclophosphamide administration & dosage
Disease-Free Survival
Etoposide administration & dosage
Fatal Outcome
Germinoma drug therapy
Germinoma mortality
Germinoma pathology
Germinoma surgery
Humans
Life Tables
Lung Neoplasms drug therapy
Lung Neoplasms secondary
Lymphatic Metastasis
Male
Mediastinal Neoplasms drug therapy
Mediastinal Neoplasms secondary
Orchiectomy
Pelvic Neoplasms drug therapy
Pelvic Neoplasms secondary
Pelvic Neoplasms surgery
Remission Induction
Retroperitoneal Neoplasms drug therapy
Retroperitoneal Neoplasms epidemiology
Retroperitoneal Neoplasms pathology
Retrospective Studies
Salvage Therapy
Teratocarcinoma drug therapy
Teratocarcinoma secondary
Teratocarcinoma surgery
Testicular Neoplasms drug therapy
Testicular Neoplasms mortality
Testicular Neoplasms pathology
Testicular Neoplasms surgery
Treatment Failure
alpha-Fetoproteins analysis
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Germinoma epidemiology
Neoplasm Metastasis
Neoplasm Recurrence, Local epidemiology
Testicular Neoplasms epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 0923-7534
- Volume :
- 8
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Annals of oncology : official journal of the European Society for Medical Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 9093706
- Full Text :
- https://doi.org/10.1023/a:1008253323854