LATE RELAPSE OF TESTICULAR CANCER

Purpose: This study analyzed a large group of patients with testicular germ cell cancer in complete remission, who relapsed more than 2 year s after completion of treatment. Patients and Methods: A review of all patients treated at Indiana University Medical Center from 1979 throu gh 1992 for late relapse was conducted. Eighty-one patients were treat ed for late relapse of testicular cancer. Forty-seven patients relapse d more than 5 years after successful management of their initial disea se. Results: At initial diagnosis, 35 patients had clinical stage I, 1 8 stage II, and 28 stage III disease. Twenty-three of 35 stage I, all 18 stage II, and all 28 stage III patients were treated by chemotherap y before their late relapse. The median follow-up duration of patients post-management of late relapse was 4.8 years. Twenty-one patients (2 5.9%) are continuously disease-free. Nineteen of these 21 patients had surgical resection of carcinoma or teratoma as a component of their t herapy. Of sixty-five patients treated for late relapse by chemotherap y, 17 (26.2%) had a complete response, but only two have been continuo usly disease-free with chemotherapy alone. These two never received pr ior chemotherapy. Conclusion: Late relapse of testis cancer is more co mmon than previously thought. Surgery is the preferred mode of therapy . Chemotherapy has only modest success in this entity, in contrast to the excellent results in de novo germ cell tumors. Patients treated fo r testicular germ cell cancer need annual follow-up evaluations throug hout their life due to the possibility of late relapse.