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Late relapse of germ cell tumors

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Abstract

Objective

To assess the main characteristics of late relapsing malignant germ cell tumors (MGCTs). These tumors are rare and occur by definition 2 years or later after successful treatment.

Methods

We present relevant literature on relapsing MGCT in order to highlight the following issues: incidence, impact of initial treatment on the subsequent risk of late relapse, treatment, and survival.

Results

A pooled analysis of 5,880 patients with MGCT revealed late relapses in 119 of 3,704 (3.2%) and in 31 of 2,176 (1.4%) patients with non-seminoma and seminoma, respectively. The retroperitoneal space is the predominant site of relapse in both histological types. The initial treatment is important for the risk and localization of late relapses. Patients with single site teratoma are usually cured by surgery alone, whereas viable MGCT or teratoma with malignant transformation may require multimodal treatment with chemo- and/or radiotherapy as well as surgery. Surgery is the most important part in the treatment of late relapses. Salvage chemotherapy should, if feasible, be based on a representative biopsy. Five-year cancer-specific survival is above 50% in the recent large series and reaches 100% in case of single site teratoma.

Conclusions

Treatment of late relapsing MGCT patients is challenging and should be performed in experienced centers only. Referral of late relapsing patients to high-volume institutions ensures the best chances of cure and enables multimodal treatment, and contributes to increased knowledge of tumor biology as well experience with the clinical course of these patients.

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Acknowledgment

This project was supported financially by The Norwegian Radium Hospital Foundation.

Conflict of interest statement

We declare to not have any conflicts of interests.

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Authors and Affiliations

  1. Department of Medical Oncology, The Norwegian Radium Hospital, Oslo, Norway

    Jan Oldenburg

  2. Buskerud University College, Institute of Health, Drammen, Norway

    Jan Oldenburg

  3. Oslo Urological University Clinic, Aker University Hospital, Oslo, Norway

    Rolf Wahlqvist

  4. Department of Clinical Cancer Research, The Norwegian Radium Hospital, Oslo, Norway

    Sophie D. Fosså

  5. Faculty of Medicine, University of Oslo, Oslo, Norway

    Sophie D. Fosså

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  1. Jan Oldenburg
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  2. Rolf Wahlqvist
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  3. Sophie D. Fosså
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Correspondence to Jan Oldenburg.

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Oldenburg, J., Wahlqvist, R. & Fosså, S.D. Late relapse of germ cell tumors. World J Urol 27, 493–500 (2009). https://doi.org/10.1007/s00345-009-0411-3

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