ACTIVE SURVEILLANCE AFTER ORCHIECTOMY FOR NONSEMINOMATOUS TESTICULAR GERM-CELL TUMORS - LATE RELAPSE MAY OCCUR

Objectives. To review the outcome of men with Stage I nonseminomatous germ cell tumors managed with a policy of active surveillance followin g orchiectomy. Methods. The clinical records of all men with Stage I n onseminomatous germ cell tumors seen at Royal Prince Alfred Hospital, Australia between 1982 and 1995 were reviewed. Data were obtained conc erning the histologic type of tumor, levels of serum tumor markers, re lapse and subsequent treatment, and survival. Results. Seventy-seven p atients were entered into the active surveillance protocol between 198 2 and 1995. With a minimum follow-up of 2 years, 27 (35%) have relapse d, with a median time to relapse of 5 months. Two late relapses occurr ed at 37 and 57 months after diagnosis. Relapses occurred most commonl y in the retroperitoneal lymph nodes, with the lungs the second most c ommon site. Following treatment with chemotherapy and surgery, all pat ients achieved complete remission, with 1 patient subsequently relapsi ng and ultimately dying of progressive tumor, One other patient died o f acute myeloid leukemia, thought to be secondary to chemotherapy. Ove rall, 75 patients (97%) remain alive and free of disease. Conclusions. Active surveillance is a safe and effective approach to the managemen t of Stage I nonseminomatous germ cell tumors. Although most relapses occur within the first 2 years, late relapses may occur. (C) 1997, Els evier Science Inc. All rights reserved.