Background: Sparse data are available with regard to the incidence,clinical characteristics, therapeutic management and prognosis of malepatients with germ cell tumors, who relapse more than two years aftercompletion of cisplatin-based chemotherapy.
Patients and methods: A review of 530 patients treated at twoinstitutions from 1978 to April 1994 was conducted. Twenty-five cases of laterelapse were identified. Cumulative risk of late relapse was calculatedaccording to the Kaplan–Meier method.
Results: 418 of 523 patients (80%) who received theirfirst-line treatment at our institutions were relapse-free at two years. Amongthese 418 patients 18 cases (4.3%) developed a late relapse. Thecumulative risk of late relapse was 1.1% at five years and 4.0%at ten years excluding patients with prior early relapses who carried risksof 9.4% and 29%, respectively (P < 0.0001).No case of late relapse was observed among patients receiving adjuvantchemotherapy. The risk of late relapse was lower in patients with good-risknon-seminomatous germ cell tumors than in poor-risk patients according toMedical Research Council criteria (P < 0.01). Seven further patientswere referred from other institutions for treatment of late relapse. At amedian follow-up of 38 months (range, 3 to 121) after treatment of laterelapse 9 of 25 patients (36%) are continuously disease-free. Six ofthese nine patients had surgical resection of carcinoma or teratoma as acomponent of their therapy.
Conclusion: The incidence of late relapse after cisplatin-basedchemotherapy of germ cell tumors is related to initial tumor burden and issomewhat higher than previously expected. Chemotherapy seems to have onlyminor curative potential, but localized resectable disease can be cured bysurgery. Annual follow-up evaluations allow to detect the majority of laterelapses at an asymptomatic stage and should be extended throughout thepatient's life.