Late recurrences in long-term survivors of XXXX .

@entity1 @entity2971 @entity5 @entity900 @entity44
@entity1 with @entity2971 who are in complete remission 2 years after treatment have a very high probability of cure, and reports of recurrences occurring after 2 years are rare. Of 81 @entity5 @entity1 treated for advanced disease at Vanderbilt University between 1970 and 1985, five developed a recurrent or metachronous germinal @entity5 58 to 195 months after the initial treatment. Only two of these @entity1 had received prior @entity900 -based combination chemotherapy. Four @entity1 had unfavorable prognostic features when @entity5 recurrence was diagnosed. All five @entity1 responded to salvage chemotherapy, although there were only two complete responses. The extent of disease was a significant factor in predicting response to salvage therapy. The possible mechanisms of development of a late recurrence of @entity5 include the following: (1) malignant degeneration of mature @entity44 to germinal @entity5 ; (2) growth of an occult @entity5 not eliminated by chemotherapy due to the presence of a blood-testicular barrier; (3) development of a second primary germ cell @entity5 ; or (4) late relapse due to persistent microscopic viable @entity5 with an atypical less aggressive biologic behavior. "Cured" germ cell @entity5 @entity1 need careful follow-up beyond 2 years. At a minimum, these @entity1 should be seen annually. @entity1 found to have @entity44 following @entity900 -based chemotherapy should probably undergo more frequent evaluations.
