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J Clin Oncol. 2019 Feb 10;37(5):396-402. doi: 10.1200/JCO.18.00790. Epub 2018 Dec 21.

Detection of Relapse by Tumor Markers Versus Imaging in Children and Adolescents With Nongerminomatous Malignant Germ Cell Tumors: A Report From the Children's Oncology Group.

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1 The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
2 Children's Oncology Group, Monrovia, CA.
3 University of Southern California, Los Angeles, CA.
4 Emory University, Atlanta, GA.
5 Yale University School of Medicine, New Haven, CT.
6 University of California Davis Comprehensive Cancer Center, Sacramento, CA.
7 University of Texas Southwestern Medical Center and Children's Medical Center Dallas, Dallas, TX.
8 Riley Hospital for Children, Indianapolis, IN.
9 St Jude Children's Research Hospital, Memphis, TN.
10 Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA.



To investigate relapse detection methods among children and adolescents with nongerminomatous malignant germ cell tumors (MGCTs) and to determine whether tumor markers alone might be sufficient for surveillance.


We retrospectively reviewed all patients enrolled in a phase III, single-arm trial for low-risk and intermediate-risk MGCTs. The method used to detect relapse was assessed based on case report forms, tumor markers, imaging, and pathology reports. Relapses were classified into one of two categories on the basis of whether they were (1) detectable by tumor marker elevation or (2) not detectable by tumor markers.


A total of 302 patients were enrolled, and 284 patients had complete data for review. Seven patients had normal tumor markers at initial diagnosis, and none experienced a relapse. At a median follow-up of 5.3 years, 48 patients (16.9%) had experienced a relapse. After central review, 47 of 48 relapses (98%) were detected by tumor marker elevation. Of the 47 patients, 16 (33.3%) had abnormal tumor markers with normal/unknown imaging, 31 patients (64.6%) had abnormal tumor markers with abnormal imaging, and one patient (2.1%) had abnormal imaging with unknown marker levels at relapse.


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.

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