TREATMENT AND OUTCOME OF PATIENTS WITH EXTRAGONADAL GERM-CELL TUMORS - THE NORWEGIAN RADIUM HOSPITALS EXPERIENCE 1979-94

This report reviews 48 patients who from 1979 to 1994 were treated at the Norwegian Radium Hospital for newly diagnosed non-cerebral extrago nadal malignant germ cell tumour (EGGCT). Based on histology and/or se rum tumour markers, 12 patients had a seminoma and 36 a non-seminoma. At diagnosis, 33 and 15 patients were classified as having abdominal a nd mediastinal EGGCT respectively. At the time of diagnosis 13 patient s, all with non-seminomatous tumours, had metastases to bone, liver or brain. One patient with abdominal seminoma was cured by radiotherapy alone, whereas cisplatin-based chemotherapy (with or without surgery) was planned in the 47 remaining patients. Twenty-seven out of 42 patie nts receiving four or more chemotherapy cycles were rendered tumour fr ee by induction chemotherapy, including 5 of the 13 patients with extr alymphatic non-pulmonal disease. An additional tumour-free patient die d of septicaemia after only two cycles of chemotherapy. Late relapses (after > 2 years) were observed in three patients, and a testicular pr imary was diagnosed during follow-up in three cases, Seven patients di ed of treatment-related complications, five of these because of neutro penic septicaemia. The median age of these patients was 52 years compa red with 35 years in the remaining 41 patients (P < 0.05). The 5-year overall survival for all 48 patients was 60% (95% CI 46-74%) [cancer-s pecific 5-year survival 71% (95% CI 50-92%)]. EGGCT is a potentially c urable disease, even in patients with very advanced disease. Special a ttention should, however, be devoted to patients above the age of 40 y ears because of an increased risk of treatment-related side-effects. L ate relapses and the subsequent development of testicular tumours indi cate the need for long-term follow-up.