Fléchon A, Culine S, Théodore C, Droz J-P
Department of Medical Oncology, Centre Léon Bérard, Lyon, France.
Eur Urol. 2005 Dec;48(6):957-63; discussion 963-4. doi: 10.1016/j.eururo.2005.06.018. Epub 2005 Jul 18.
We performed a retrospective analysis of first relapses after cisplatin-based chemotherapy in patients with advanced germ-cell tumors, in order to better define the appropriate follow-up.
These patients were treated between 1986 and 1998 in two institutions. They were either followed after first-line chemotherapy at the same center or referred for relapse.
Ninety-six patients relapsed (17.5% of the total number of patients treated in the same time period). Thirty-five (36.4%) patients had serum tumor marker levels (AFP, hCG and LDH) normal values. Sites of relapse were: abdominal in 47 (49%) patients, thoracic in 17 (17.7%), thoraco-abdominal in 15 (15.6%), and brain in 8 (8.3). Seven (7.3%) patients had elevated markers only, 1 (1%) had isolated supra-clavicular lymph node, 1 (1%) had bone metastasis only. Eighty-two patients (85%) relapsed during the first 18 months of follow-up. All patients with brain metastases at relapse and those who obtained sCR after chemotherapy relapsed within 8 months of follow-up. Sixteen patients underwent resection of growing teratoma.
These results allow to recommend extensive follow-up during the first two years after response to first line treatment. It includes marker level determination and whole body CT scan and less intensive work-up there after.
我们对晚期生殖细胞肿瘤患者基于顺铂的化疗后的首次复发进行了回顾性分析，以便更好地确定合适的随访方案。
这些患者于1986年至1998年在两家机构接受治疗。他们要么在同一中心接受一线化疗后接受随访，要么因复发而被转诊。
96例患者复发（占同期治疗患者总数的17.5%）。35例（36.4%）患者的血清肿瘤标志物水平（甲胎蛋白、人绒毛膜促性腺激素和乳酸脱氢酶）为正常数值。复发部位为：腹部47例（49%），胸部17例（17.7%），胸腹联合部15例（15.6%），脑部8例（8.3%）。7例（7.3%）患者仅肿瘤标志物升高，1例（1%）有孤立的锁骨上淋巴结转移，1例（1%）仅有骨转移。82例（85%）患者在随访的前18个月内复发。所有复发时伴有脑转移的患者以及化疗后获得完全缓解的患者在随访8个月内均复发。16例患者接受了生长性畸胎瘤切除术。
这些结果表明，建议在一线治疗缓解后的头两年进行广泛随访。这包括肿瘤标志物水平测定和全身CT扫描，之后的检查强度可降低。
