Successful treatment of patients in whom germ cell tumour masses enlarged on chemotherapy while their serum tumour markers decreased.

Enlargement of tumour masses with a fall or no change in tumour marker levels was noted in eight of 287 patients during chemotherapy for NSGCT at the Charing Cross and Mount Vernon Hospitals between 1977 and 1988. These eight patients had elements of differentiated teratoma in the primary specimen and in five the enlarging masses showed cystic change on CT scan. The increase in tumour mass occurred within 6 months of starting treatment. At surgery, four patients were found to have differentiated teratoma and have been followed for 15 months to 5 years without relapse. Two patients who also had some areas of embryonal carcinoma in the resected specimens had post-operative chemotherapy and are alive disease free at 8 and 24 months respectively. Two patients died: one post-operatively of uncontrolled haemorrhage secondary to aortic rupture and the second of acute myeloid leukaemia following 8 years of intermittent therapy for unresectable differentiated teratoma. The successful outcome in six of these eight patients suggests that enlarging teratomatous masses on chemotherapy can be managed by surgical resection and, when active tumour is present, by the use of post-operative chemotherapy.