R. Ravi et al., A SINGLE-CENTER OBSERVATIONAL STUDY OF SURGERY AND LATE MALIGNANT EVENTS AFTER CHEMOTHERAPY FOR GERM-CELL CANCER, British Journal of Urology, 80(4), 1997, pp. 647-652
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.