Late CT surveillance in nonseminoma germ cell tumors (NSGCT).

Abstract

223 Background: Testicular cancer is the commonest solid malignancy in 18-35 year old men. With the introduction of cisplatin, most patients with metastatic disease are cured.Over recent years a risk of late relapse (>2 years after first line therapy) has been recognised in 2- 6% of NSGCTs. Appropriate follow-up strategies have not been determined. To investigate, the utility of long term CT surveillance we initiated a study to see if late CT could detect late relapses at an early stage. Methods: Eligible patients had been treated for Stage IM – Stage IV NSGCT diagnosed 5 years prior to entry. CT scans were at study entry and 5 years. Patients are reviewed annually with tumour markers and clinical examination. We plan to recruit 300 patients. This reports details the outcome of a planned interim analysis of the first round of screening after recruiting 100 patients Results: 108 patients have been enrolled into the study since 2006. Full clinical data was available for 88 patients. Median age was 31 years at diagnosis. 52 patients had evidence of teratoma differentiated (TD) in the primary.Stage at treatment was IM (1), II (45), III (6) and IV (36). Treatment was BEP [bleomycin, cisplatin and etopside (3 cycles: 30), (4 cycles: 20)], CBOP/BEP (16) and other platinum schedule (8) at diagnosis. 27 patients relapsed.Overall 38 had retroperitoneal lymph node.TD noted in 28. 10 had a metastatectomy [brain (2), pelvic mass (1:TD), pulmonary (6;TD:2), neck (2), iliac node (1:TD)]. Study scan was reported normal in 71 patients. None of these have relapsed however 1 patient died of interval lung cancer. Radiological abnormalities were identified in14 patients. 4 underwent surgery (3 RPLND and 1 lung nodule excision). 2 were benign and 2 had TD.1 patient had liver lesions proven to be cysts on ultrasound. 8 had small volume nodal abnormalities which are stable on repeat imaging. 1 is on annual CT surveillance for indeterminate lung nodules.4 patients are awaiting the initial study scan Conclusions: Late CT scan detected significant abnormalities in patients treated for NSGCT leading to surgery. Abnormalities not deemed appropriate for surgical intervention are being followed up surveillance scans. No significant financial relationships to disclose.