Detection of Relapse in Children and Adolescents With Nongerminomatous Malignant Germ Cell Tumors


Key Points

  • 98% of relapses were identified by elevation in tumor markers.
  • Approximately one-third of relapses had abnormal tumor markers and normal/unknown imaging.

In a report from the Children’s Oncology Group published in the Journal of Clinical Oncology, Fonseca et al found that relapse in children and adolescents with nongerminomatous malignant germ cell tumors (MGCTs) was most frequently identified by tumor markers rather than imaging.

Study Details

The study involved data from 284 patients with complete data for review (of a total of 302 patients) enrolled in a phase III single-arm trial for low-risk and intermediate-risk MGCTs. The method for detecting relapse was assessed based on case report forms, tumor markers, imaging, and pathology reports. Relapses were classified according to whether they were detectable by tumor marker elevation or not detectable by tumor markers.

Relapse Identification

Median follow-up was 5.3 years. Among the 284 patients, relapse occurred in none of 7 with normal tumor markers at diagnosis. Overall, relapse occurred in 48 patients (16.9%). On central review, 47 (97.9%) of the 48 relapses were identified by tumor marker elevation. Of these 47 patients, 16 (33.3%) had abnormal tumor markers with normal/unknown imaging and 31 (64.6%) had abnormal tumor markers with abnormal imaging; 1 patient (2.1%) had abnormal imaging with unknown marker levels at relapse.

The investigators concluded, “Tumor marker elevation is a highly sensitive method of relapse surveillance, at least among children and adolescents with tumor marker elevation at initial diagnosis. Eliminating exposure to imaging with ionizing radiation may enhance the safety of relapse surveillance in patients treated for MGCT.”

Adriana Fonseca, MD, of the Division of Haematology Oncology, University of Toronto, The Hospital for Sick Children, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study authors’ full disclosures can be found at

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