Treatment of markeronly late relapse

In the study by Gerl and colleagues [9], an increase in AFP occurred in 16 patients with late relapse. In 12 of them, the increase was documented 6 to 44 months (median 27 months) before radiological detection of the tumor. Other reports have confirmed this observation [5,7,17,36]. In one case, late relapse was diagnosed solely on the basis of an elevation in HCG [17]. Positron emission tomography identified the disease site in only a minority of patients. Ultimately, the disease was detected in most patients by computed tomography scan [17]. Given the unfavorable results of chemotherapy at late relapse, it is reasonable to withhold any treatment until the disease site is apparent and amenable to surgical excision.

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