Clinical characteristics and outcome of late relapse after cisplatin-based chemotherapy of germ cell tumor. An update

Abstract

4529 Background: Late relapse of germ cell tumor (GCT) is defined as recurrence after an interval of more than 2 years from initial therapy. Data on clinical characteristics and outcome of patients with late relapses of GCT are sparse. Methods: The charts of 37 patients treated for late relapse after cisplatin-based chemotherapy for GCT from 1983 through 2002 were reviewed (non-seminoma n=36, pure seminoma n=1). Results: Time to late relapse ranged from 25 to 191 months (median 66 months; > 5 years n=21 [57%], > 10 years n=5 [14%]). Tumor marker AFP was elevated in 21 of 36 patients (58%), HCG in 6 cases (17%). The most frequently involved site was the retroperitoneum n=17 (46%) followed by mediastinum n=9 (24%), pelvis, retrocrural space, neck, lung and liver (each site n=4 [11%]). 5 patients (14%) had a late relapse with pure teratoma. 2 patients refused any treatment, 24 patients (65%) underwent chemotherapy as initial treatment for late relapse, 11 patients (30%) surgery. After initial therapy for late relapse 19 patients (51%) achieved no evidence of diesase (NED) status, 9 of whom relapsed again (5 with a second late relapse). After a median follow-up of 52 months (range, 9–168 months) 17 patients (46%) are alive with NED (15 of 27 patients [56%] with disease at one antomic site only), 10 patients (27%) continuously and 7 (19%) after further treatment. 30 patients underwent chemotherapy for management of late relapse or subsequent recurrence, 3 (10%) of whom achieved a durable NED status to chemotherapy alone (1 patient to oral etoposide after failure of high-dose chemotherapy). Conclusions: Resectable disease at one anatomic site is a predictor for favorable outcome of treatment for late relapse. Durable response to chemotherapy alone is rare but occurs even in heavily pretreated patients. As the risk for second late relapse is substantial, lifetime follow-up is necessary. No significant financial relationships to disclose.