Late relapse of germ cell tumors: Detection and treatment outcomes.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 5007-5007
Author(s):  
Noah Hunter Richardson ◽  
Sandra K. Althouse ◽  
Ryan Ashkar ◽  
Clint Cary ◽  
Timothy A. Masterson ◽  
...  
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
Late Relapse ◽  
Survival Outcomes ◽  
Screening Methods ◽  
Indiana University ◽  
Primary Tumor Site ◽  
Optimal Screening ◽  
Relapsed Disease ◽  
Treatment Surgery

5007 Background: Late relapse (LR) of germ cell tumors (GCT) is defined as relapsed disease > 2 years from initial treatment. LR remains a challenge both for optimal screening methods and treatment. We report the method of detection, treatments received, and outcomes in patients with LR GCT. Methods: The prospectively maintained Indiana University testicular cancer database was queried identifying 2712 pts with GCT treated at Indiana University from January 2000 to January 2019. Method of detection of LR was recorded along with site, treatment received, chemo-naive vs chemo-exposed LR, and survival outcomes. Results: 90 pts with LR were identified. Median age at LR was 35.2 yr (range, 19.2-56.8). Primary tumor site was testis in 88 (98%), retroperitoneum in 1 (1%), and mediastinum in 1 (1%). Chemo-exposed accounted for 42 (47%) and chemo-naïve for 48 (53%) of cases. Table compares clinical characteristics and survival outcomes of chemo-exposed vs. chemo-naïve late relapse. 62% of chemo-exposed LR were diagnosed with elevated AFP. For the 42 chemo-exposed LR pts, 2-yr PFS based on treatment: surgery vs. chemo vs surgery+chemo was 48% vs 10% vs 45% (p = 0.105). For the 48 chemo-naïve LR pts, 2-yr PFS based on treatment: surgery vs. chemo vs. surgery+chemo was 100% vs 74% vs 37% (p = 0.004). Next generation sequencing was available for 9 patients. No actionable findings were found. Tumor mutational burden was low in all patients where genomic testing was available. Conclusions: Most pts with chemo-exposed LR will be diagnosed with an elevated AFP. GCT pts require lifetime follow-up with annual physical exam and tumor markers. Surgical resection, when feasible, remains our preferred treatment for chemo-exposed LR as chemotherapy alone offers only brief responses. Pts with chemo-naïve LR have more chemo-sensitive biology.[Table: see text]

Aggressive surgical management of germ cell tumors with somatic-type malignancy: Pathologic features, prognostic factors, and survival outcomes.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4554-4554
Author(s):  
Kevin R Rice ◽  
Martin J Magers ◽  
Stephen Beck ◽  
Lawrence H. Einhorn ◽  
Thomas M. Ulbright ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Germ Cell ◽  
Germ Cell Tumors ◽  
Tumor Grade ◽  
Late Relapse ◽  
Testis Cancer ◽  
Risk Category ◽  
Delayed Presentation ◽  
Primary Tumor Site ◽  
Pathologic Features

4554 Background: Germ cell tumors (GCT) with somatic-type malignancy (SM) are rare occurring in approximately 3-8% of GCT cases. Prognostic factors and optimal management remain poorly-defined. Methods: The Indiana University (IU) testis cancer database was queried from 1979 to 2011 for patients demonstrating atypical histology at orchiectomy or subsequent resection of metastatic disease. Patients with transformation to PNET only were excluded due to distinct management. Chart review, pathologic review, and survival analysis were performed. Results: 122 patients met study inclusion criteria. Primary tumor site was testis in 112, retroperitoneum in 8, groin in 1, and pineal gland in 1. The most common SM histologies were sarcoma (71) and carcinoma (32). At GCT diagnosis, 24, 44, 45 patients had stage I, II, and III disease, respectively. Stage was unknown in 9. Median time from GCT diagnosis to SM was 13 months (Range, 0-397). This interval was longest for carcinomas (94.5 months) and sarcomatoid yolk sac tumors (113 months). Only 11 of 83 patients (13.3%) receiving cisplatin-based chemotherapy for measurable disease demonstrated an initial complete response. First resection at IU was reoperative in 45 patients (36.9%). 69 patients (56.6%) required extirpation of abdominal viscera/vascular structures or distant metastases. At a median follow-up of 71 months, the 5-year cancer specific survival (CSS) was 63%. Predictors of poorer CSS included SM diagnosed at late relapse (p = 0.014), referral to IU for reoperative RPLND (p = 0.022), and tumor grade (p = 0.043). SM histology subtype, stage, risk category, and number of resections for SM were not predictive of CSS. Conclusions: GCT with SM is associated with poorer CSS than traditional GCT. Established prognostic factors for GCT lose their predictive value in the setting of SM. SM can occur at any point in the course of GCT, but has a propensity for delayed presentation with later onset being associated with poorer CSS. Aggressive and serial surgical resections are often necessary to optimize CSS. Tumor grade is an important prognostic factor, particularly in sarcoma cases.

Salvage chemotherapy with high dose carboplatin + etoposide (HDCE) and peripheral blood stem cell transplant (PBSCT) in patients with germ cell tumors (GCT)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4549-4549 ◽  
Author(s):  
L. H. Einhorn ◽  
S. Williams ◽  
R. Abonour
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
Salvage Chemotherapy ◽  
Late Relapse ◽  
High Dose ◽  
Cell Transplant ◽  
Cure Rate ◽  
Indiana University ◽  
Prior Therapy ◽  
Hematopoietic Recovery

4549 Background: We began studies with HDCE for patients (pts.) with recurrent GCTs 20 years ago. During the past decade, better supportive care and use of PBSCT allowed outpatient therapy and more rapid hematopoietic recovery between the 2 courses of HDCE. Methods: Retrospective review of 184 consecutive pts. treated with HDCE at Indiana University from 2–96 to 12–04. Late relapse (> 2 years from prior therapy) and primary mediastinal non-seminomatous germ cell tumor pts. were not offered HDCE. Cytoreduction with 0–2 courses of vinblastine + ifosfamide + cisplatin preceded HDCE. C dosage was 700 mg/M2 × 3 and E 750 mg/M2 × 3. A second course was given after hematologic recovery. Results: Toxicity was as previously described (JCO 18:3346, 2000). There were 3 drug- related mortalities. An additional 3 patients developed AML (2 fatal), and 1 glioma following CNS XRT for metastases. 11 pts. did not receive second course (8 due to progression or HDCE mortality). Median time to second course HDCE was 28 days (range 20 to 42). 116 of 184 pts. are alive and continuously (cont) NED (63%) with median followup 42 months (range 11 to 118). 113 (97%) of these are 12+ months NED. 5 additional pts. are currently NED with further therapy. Results are tabulated below. Conclusions: HDCE has a high cure rate with acceptable toxicity as salvage therapy for GCT pts. [Table: see text] [Table: see text]

scholarly journals GCT-28. RECURRENCE PATTERN AND SURVIVAL FOR RELAPSED INTRACRANIAL NON-GERMINOMATOUS GERM CELL TUMORS: A SINGLE-INSTITUTION EXPERIENCE

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii333-iii333
Author(s):  
Lei Wen ◽  
Zhaoming Zhou ◽  
Qingjun Hu ◽  
Juan Li ◽  
Mingyao Lai ◽  
...  
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
Late Recurrence ◽  
Salvage Chemotherapy ◽  
Recurrence Time ◽  
First Line ◽  
Primary Tumor Site ◽  
First Line Therapy ◽  
Line Therapy

Abstract PURPOSE Intracranial non-germinomatous germ cell tumors (NGGCTs) have lower overall survival than germinoma because relatively higher recurrence usually occurs after first line therapy. METHODS Between January 2003 and December 2018, 111 consecutive patients diagnosed with NGGCTs reviewed. Those who progressed after first line therapy were included in this study. Data of first line treatment, salvage treatment, clinicopathological features and survival were collected and analyzed. RESULTS Totally, thirty patients (30/111, 27.0%) relapsed in our cohort, including 19 patients with accurate relapse information detail, and 11 patients who died of disease progression during follow up but without exact time and site of relapse. The median OS from diagnosis of the disease was 49.2 months (95% CI: 14.1 to 84.3 months) and 3-year OS was 54.3%. Patients who received both CSI and chemotherapy relapsed less than those who received reduced volume of radiotherapy or only CSI or only chemotherapy (22.5% vs. 45.5%, p=0.034). Of 19 patients who had detail information of recurrence time and site, the median time from diagnosis of disease to relapse was 9.5 months (2.2 to 72.1 months). Regarding to recurrence site, most patients relapsed in primary site (10/19, 52.6%) or distant intracranial (6/19, 31.6%). The recurrence site of other 3 patients were spinal (n=1), ventricular (n=1) and peritoneal (n=1). CONCLUSION Protracted follow-up is recommended because late recurrence is not uncommon. Primary tumor site and distant intracranial are the most prevalent relapsed location. Patients who relapsed could benefited from both CSI and salvage chemotherapy.

scholarly journals Late and Rapid Relapse in Mediastinum from Testicular Germ Cell Tumor Stage I Over 13 Years after Surgery

2019 ◽  
Vol 12 (2) ◽  
pp. 500-505
Author(s):  
Toshirou Fukushima ◽  
Takuro Noguchi ◽  
Takashi Kobayashi ◽  
Nodoka Sekiguchi ◽  
Takesumi Ozawa ◽  
...  
Keyword(s):  
Germ Cell ◽  
Mediastinal Lymph Node ◽  
Relevant Literature ◽  
Germ Cell Tumors ◽  
Stage I ◽  
Careful Examination ◽  
Late Relapse ◽  
Testicular Germ Cell Tumors ◽  
Testicular Germ Cell ◽  
Testicular Seminoma

Patients with stage I testicular germ cell tumors have a long life expectancy, but the tumors have a potential to relapse after treatment. Although relapse is observed within a few years in most cases, late relapse over 10 years after initial treatment has also been reported in patients with stage I testicular germ cell tumors. We encountered a case of testicular seminoma that developed mediastinal lymph node metastasis 13 years after radical surgery for the primary tumor. The relapsed disease progressed rapidly and the patient died within 1 month due to respiratory failure without any chance for therapy. On postmortem examination, the thoracic lesions were pathologically confirmed to be metastases from the testicular seminoma with yolk sac tumor. Here, we report the clinical course and a review of the relevant literature. Based on our experience, we emphasize long-term follow-up and/or careful examination in patients with stage I testicular germ cell tumors.

Ifosfamide- and cisplatin-containing chemotherapy as first-line salvage therapy in germ cell tumors: response and survival.

1997 ◽  
Vol 15 (7) ◽  
pp. 2559-2563 ◽  
Author(s):  
J A McCaffrey ◽  
M Mazumdar ◽  
D F Bajorin ◽  
G J Bosl ◽  
V Vlamis ◽  
...  
Keyword(s):  
Germ Cell ◽  
Median Survival ◽  
Primary Tumor ◽  
Median Survival Time ◽  
Germ Cell Tumors ◽  
Tumor Site ◽  
First Line ◽  
Primary Tumor Site ◽  
First Line Therapy ◽  
Line Therapy

PURPOSE To evaluate the efficacy and toxicity of ifosfamide- and cisplatin-containing chemotherapy as first-line salvage treatment for patients with germ cell tumors (GCT). PATIENTS AND METHODS Fifty-six patients with advanced GCT resistant to one prior cisplatin-containing regimen were treated with a salvage chemotherapy regimen of ifosfamide, cisplatin, and either vinblastine or etoposide (VeIP/VIP). RESULTS Twenty of 56 (36%) assessable patients achieved a complete response (CR). Thirteen (23%) are alive and continuously free of disease at a median follow-up time of 52 months; the median survival duration was 18 months. Among patients with a testis primary tumor site and a prior CR to first-line therapy, 65% are alive and 41% continuously disease-free, and the median survival time has not been reached. In contrast, for patients with an extragonadal primary tumor or with a testis primary tumor site and an incomplete response (IR) to first-line therapy, 31% are alive and 15% continuously free of disease, with a median survival time of 12 months (P < .03). CONCLUSION Ifosfamide- and cisplatin-containing therapy achieves a durable CR in a minority of patients with resistant GCT as first-line therapy. Patients with a primary testis site who relapsed from a CR to first-line cisplatin therapy have a better prognosis than patients with an extragonadal primary tumor site or an IR to first-line therapy. Risk-directed clinical trials to improve response and survival in both subsets are warranted.

Late Relapse of Testicular Germ Cell Tumors

2015 ◽  
Vol 42 (3) ◽  
pp. 359-368 ◽  
Author(s):  
Matthew J. O’Shaughnessy ◽  
Darren R. Feldman ◽  
Brett S. Carver ◽  
Joel Sheinfeld
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
Late Relapse ◽  
Testicular Germ Cell Tumors ◽  
Testicular Germ Cell

A retrospective analysis of patients with poor-risk germ cell tumor (PRGCT) treated at Indiana University from 2000 to 2010.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4557-4557
Author(s):  
Nabil Adra ◽  
Costantine Albany ◽  
Daniel Sonnenburg ◽  
Yan Tong ◽  
Nasser H. Hanna ◽  
...  
Keyword(s):  
Germ Cell ◽  
Retrospective Analysis ◽  
Tumor Markers ◽  
Germ Cell Tumor ◽  
Germ Cell Tumors ◽  
Continuous Variable ◽  
Cell Tumor ◽  
P Value ◽  
Indiana University ◽  
Poor Risk

4557 Background: PRGCT represents 14% of germ cell tumors, with 2-year PFS of 50%. PRGCT is defined by primary mediastinal non-seminomatous germ cell tumor (PMNSGCT), non-pulmonary visceral metastasis (NPVM), AFP > 10,000 or hCG > 50,000. This analysis attempts to identify subsets of patients with more or less favorable outcomes among the poor risk groups. Methods: Retrospective analysis of all patients with testicular cancer seen at Indiana University (IU) from 2000-2010. 291 patients with PRGCT identified of whom 79 received initial therapy at IU. We analyzed the following variables: primary site testis/retroperitoneal (T/RP) vs. PMNSGCT, pulmonary vs. NPVM, and the amplitude of serum tumor markers. We identified groups of patients according to the level of tumor marker elevation with cutoff points of AFP 20,000 and hCG 200,000. Results: Mean age 29, mean AFP 8,283, mean hCG 185,667. 24% had PMNSGCT, 48% NPVM, 11% AFP>20,000, and 25% hCG>200,000. When hCG was analyzed as a continuous variable, every 10,000 unit increase in hCG caused the hazard of progression to increase by 1% (p value 0.01). Patients with NPVM had significantly worse PFS. NPVM with elevated hCG had worse outcome than NPVM with normal hCG. This did not correlate as well with AFP. PFS was worse with NPVM than elevated pre-chemotherapy tumor markers. Multiple different criteria for poor risk disease carried significantly worse impact on PFS and OS when compared to having a single criterion for poor risk disease. Conclusions: Our data indicate that patients with NPVM or more than one criteria for PRGCT have a worse outcome compared to other PRGCT subgroups. [Table: see text]

Germ Cell Tumors: Looking to the Future

2015 ◽  
pp. e253-e258
Author(s):  
George J. Bosl
Keyword(s):  
Germ Cell ◽  
Primordial Germ Cells ◽  
Tumor Biology ◽  
Chemotherapy Resistance ◽  
Germ Cell Tumors ◽  
Late Relapse ◽  
Malignant Neoplasms ◽  
Second Malignant Neoplasms ◽  
Near Term

Our knowledge about the management of men with germ cell tumors (GCTs) and its tumor biology continues to evolve. Vascular disease, metabolic syndrome, second malignant neoplasms, and hypogonadism occur after treatment for GCTs and the latency pattern resembles that seen in patients treated for Hodgkin lymphoma. Patients receiving treatment for GCTs should be informed not only of the near-term toxicity (experienced during or shortly after administration), but also the delayed and late effects of chemotherapy and the need for lifelong surveillance for all late outcomes, including late relapse. Recent data suggest that the treatment outcome of patients with intermediate-risk, poor-risk, and relapsed GCTs can be improved through multicenter trials that include the general oncology community. Finally, GCTs are a malignancy of primordial germ cells. Programmed differentiation is clinically evident in vivo and probably related to chemotherapy resistance. This biology has much clinical relevance, some of which is already in use.

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