Late relapse in chemotherapy-treated germ cell tumour patients

Late relapse of germ cell cancer is defined as recurrence more than two years after the completion of primary therapy. Sparse data are available in the medical literature regarding incidence, clinical features, therapeutic management and outcome of patients with late relapses. We therefore reviewed the charts of 550 patients treated with chemotherapy at two institutions during the cisplatin era. Four hundred and thirty four patients (80%) were relapse-free at two years after primary therapy, 19 of whom (4.4%) developed a late relapse. Seven further patients were referred from other institutions for treatment of a late relapse. Time to late relapse ranged from 25 to 132 months, with a median of 65 months. Twenty cases of late relapse were diagnosed in connection with routine follow-up evaluation. At a median follow-up of 45 months (range, 3 to 121) after treatment for late relapse 10 patients (38%) remain continuously disease-free. Only two of these ten patients achieved a durable complete response to salvage chemotherapy alone. Seven of the remaining eight patients underwent resection of cancer or teratoma as a component of their therapy. We conclude that the incidence of late relapse of germ cell rumours after cisplatin-based chemotherapy is somewhat higher than previously expected. Localised resectable disease can be cured by surgery, whereas chemotherapy seems to have only minor curative potential. Annual follow up evaluations allow the detection of the majority of late relapses at an asymptomatic stage and should be extended throughout the patient's hfe.