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Late relapse (>2 years) on surveillance in stage I non seminomatous germ cell tumours; predominant seminoma only histology

Record type: Article

Study Type – Therapy (case series) Level of Evidence 4.

OBJECTIVES:
Surveillance is a standard management approach following orchidectomy for stage I non-seminomatous and mixed germ cell tumours. Patients who relapse following this approach are treated with cisplatin-based chemotherapy, with retroperitoneal lymph node dissection considered for patients with post-chemotherapy residual masses.

PATIENTS AND METHODS:
We reviewed the clinicopathological data for all patients who relapse greater than 24 months after commencing our surveillance programme.

RESULTS:
Between 1989 and 2008, 453 patients with a median age of 30 years were entered into our surveillance program for stage I non-seminomatous germ cell tumours (NSGCTs) after orchidectomy alone. All primary tumour specimens contained NSGCT, with seminomatous elements identified in 168 cases (37%). One-hundred patients (22%) relapsed and the majority of relapses occurred within the first 2 years (76 ? 12 months, 15 ? 12 months ? 2 years). Nine patients relapsed after more than 2 years of surveillance. We found a high incidence of pure seminoma (56%) at sites of metastatic disease in this group. All late-relapsing patients were alive and disease free at a median follow up of 45 months from relapse.

CONCLUSIONS:
We recommend that late-relapsing patients with normal serum alpha fetoprotein levels undergo biopsy to define histologically the nature of recurrent disease. In those with pure seminoma retroperitoneal lymph node dissection for post chemotherapy residual masses can be avoided.

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Citation

Nolan, Luke, Wheater, Matthew, Kirby, Julie, Simmonds, Peter and Mead, Graham (2010) Late relapse (>2 years) on surveillance in stage I non seminomatous germ cell tumours; predominant seminoma only histology BJU International, 106, (11), pp. 1648-1651. (doi:10.1111/j.1464-410X.2010.09471.x). (PMID:20735393).

More information

e-pub ahead of print date: 24 August 2010
Published date: December 2010
Keywords: late relapse, seminoma, surveillance, germ cell cancer

Identifiers

Local EPrints ID: 79443
URI: http://eprints.soton.ac.uk/id/eprint/79443
ISSN: 1464-4096
PURE UUID: 6bb5ebad-ed21-48a4-a3d5-4b0ab470c865

Catalogue record

Date deposited: 16 Mar 2010
Last modified: 11 Jul 2017 09:51

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Contributors

Author: Luke Nolan
Author: Matthew Wheater
Author: Julie Kirby
Author: Peter Simmonds
Author: Graham Mead

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