A SINGLE-CENTER OBSERVATIONAL STUDY OF SURGERY AND LATE MALIGNANT EVENTS AFTER CHEMOTHERAPY FOR GERM-CELL CANCER

Objective To review the impact of surgical staging after treatment on the late malignant events in an unselected group of patients treated w ith chemotherapy for germ cell cancer of the testis over the last 16 y ears. Patients and methods The study comprised 256 patients treated be tween 1978 and 1994 who were reviewed for late relapse and development of second germ cell and non-germ cell cancer. Results At diagnosis, 1 42 patients had clinical stage 2, 30 stage 3 and 84 stage 4 disease; 5 7 patients relapsed within 20 months of treatment, while late germ-cel l cancer relapses (greater than or equal to 24 months after treatment) occurred in six patients. Of patients relapsing early or late, 42% an d 33%, respectively, received surgery after treatment. Only two of tho se relapsing late remain progression-free with further treatment. Four patients developed germ cell cancer in the contralateral testis, whil e six developed second non-germ cell cancers. Conclusion Late events o ccurred in 6.2% of 256 patients in this series, from 29 to 141 months after treatment. Given that the late relapse rate of six of 256 (2.3%) is less than the incidence of mature teratoma at routine retroperiton eal lymph node dissection, more patients may eventually relapse. These results suggest that there might be a case to evaluate the use of ult rasonographic surveillance of the retroperitoneum and testis at 5, 10 and 20 years, in addition to extending routine surveillance.