Luigi Frigerio

Background and aims: Optimal treatment of recurrent GCTs is unknown. The aim of this study was to evaluate characteristics and treatment of recurrent GCTs.

Methods: Data concerning 35 recurrent GCTs treated at MITO centers were reviewed.

Results: FIGO stage was: 11 IA, 11 IC, 6 Ix, 1 IIB, 5 IIIC and 1 IV. All patients had undergone primary surgical treatment, plus adjuvant chemotherapy in 7 cases. The median recurrence free survival was 53.2 months with difference between patients receiving adjuvant chemotherapy (72.5 months) and not (48 months) and between patients with surgical staging (47 months) and without (64.5 months). Recurrence sites were: pelvic, 13; abdominal, 6; lymph-nodal 2; pelvic+ abdominal, 7; abdominal+lymph-nodal, 4; pelvic+ lymph-nodal, 3. Twenty-five patients underwent debulking surgery+chemotherapy, 7 surgery, 1 surgery+radiotherapy, 1 chemotherapy and 1 palliation. 69% of patients completed chemotherapy. No difference was found in OS among patients receiving or not chemotherapy at recurrence and among sites. Eleven patients developed a second relapse after a median time of 38 months. 81.8% had received chemotherapy at first recurrence. Four patients underwent surgery, 4 surgery+chemotherapy, 1 surgery+radiotherapy and 2 palliation. Four patients developed a third recurrence after a median time of 41 months. Two patients received chemotherapy and 2 hepatic resection+thermo-ablation. Nine patients (25.7%) died of disease (11.4%, 30% ,50% at first, second and third relapse, respectively). 10y-OS was 87.6% and 71% for I and advanced stage, respectively (p< 0.05).

Conclusions: Patients should always be treated in case of recurrence. Surgery remains the cornerstone at relapse.