Abstract: PD53-04
Sources of Funding: None

Introduction

Late relapse (LR) of nonseminomatous germ cell tumours (NSGCTs), defined when this occurs > 2 years following successful treatment, is uncommon. We have examined the features and management of LR in NSGCT’s presenting to our institution.

Methods

Of 2490 patients, 90 were referred with LR of NSGCT. LR occurred at a median of 84 months (range 25-504, mean 131.7) following treatment. With their initial disease 23 had stage 1 disease with the other 67 all receiving chemotherapy for metastatic disease. Of these, 38 also had a post chemotherapy retroperitoneal lymph node dissection (PC-RPLND) for residual mass with histology showing 31 teratoma differentiated (TD) only, 3 necrosis and 3 had TD with viable tumour and 1 with TD and de-differentiated (DD) cancer.

Results

In 30 cases patients presented with symptoms of LR, with the remainder detected by markers and imaging. Of the 38 patients who had prior PC-RPLND 12 experienced a LR exclusively in the retroperitoneum with 7 relapsing in the retroperitoneum and other sites. Surgical resection was undertaken in 74 cases of LR with 11 receiving chemotherapy prior. In patients who had surgical resection initially - 38 had TD only, 22 had cancer with 7 having viable GCT and 4 viable GCT with TD and 11 having DD elements, 2 were benign and 1 not available. In those who had chemotherapy prior to resection - 5 had pure TD with 4 having cancer (2 of these were associated with TD or DD) and 2 had fibrosis/necrosis. To date 19 patients have died of disease (13 represented with symptoms and 11 occurred in multiple sites).

Conclusions

LR in NSGCT is rare and presents > 5 years in the majority of cases. Mortality is strongly linked to symptomatic and/or multiple sites of recurrence. TD is the predominant component of LR - related to incomplete surgical clearance following PC-RPLND where pathology demonstrates TD as well radiologically unrecognised foci of TD in stage 1 disease or following systemic disease. This reinforces the need for an aggressive surgical approach for PC residual masses in terms of completeness of the templates as well as closer scrutiny of equivocal nodal enlargement in surveillance and following chemotherapy.

Funding

None