Rezidivtherapie und Prognosefaktoren im Rezidiv bei Hodentumoren

The majority of patients with germ cell tumors who fail first-line treatment will still be cured. Patients without first-line chemotherapy who fail surveillance, radiotherapy, or surgery are managed according to the treatment algorithms for primary metastatic disease. These patients will usually be rendered disease-free with three to four cycles of cisplatin, etoposide, and bleomycin. Salvage treatment of patients who relapse after first-line chemotherapy is complex and requires an experienced and highly specialized team. For patients with early relapse less than 2 years after first-line treatment, two strategies may be pursued: first, four cycles of conventional-dose chemotherapy with cisplatin, ifosfamide and either etoposide, paclitaxel, or vinblastine; second, early intensification of first-salvage treatment using sequential high-dose chemotherapy. Prognostic factors help in selecting the optimal salvage strategy. Additional salvage surgery is frequently required after completion of salvage chemotherapy to completely resect all radiologic residual manifestations. Patients with brain metastases should receive whole-brain radiation upfront, concurrent with salvage chemotherapy. Patients with late relapse more than 2 years after first-line treatment should receive immediate salvage surgery whenever this is technically feasible.