Once therapy is completed, the method of surveillance is based on the clinical and histologic characteristics of the primary tumor. For example, dysgerminomas and pure immature teratomas often have low or normal tumor markers at diagnosis and thus can be followed up only with a combination of interval history, physical examination, and imaging as clinically indicated. In contrast, endodermal sinus tumors (with their characteristically elevated AFP) have a sensitive, reproducible marker of persistent or recurrent disease. In the setting of mixed tumors, surveillance can be individualized when one or more tumor markers were elevated before therapy and have responded as expected to definitive management.
In general, follow-up should be at regular intervals for at least 2 years, since 75% of recurrences occur within the first year after completion of therapy.92 Although no recommendations for contraception have been formalized, it is reasonable to delay pregnancy (if possible) during the first year of follow-up if tumor markers are being used for disease surveillance.
Second-look laparotomy has not been shown to improve outcomes for patients with dysgerminomas or early-stage immature teratomas.98,108 However, some have suggested that in the setting of advanced-stage immature teratomas, second-look laparotomy may be of benefit since these tumors have no reliable tumor markers.92 There have been no studies comparing post-therapy imaging as a replacement for second-look surgery in this setting.
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