Outcomes following surgery for primary mediastinal nonseminomatous germ cell tumors in the cisplatin era

Abstract

Objective: Treatment of primary mediastinal nonseminomatous germ cell tumors involves cisplatin-based chemotherapy followed by surgery to remove residual disease. We undertook a study to determine short and long-term outcomes.Methods: A retrospective analysis of patients with primary mediastinal nonseminomatous germ cell tumors who underwent surgery at our institution from 1982 to 2017 was performed.

Primary mediastinal germ cell tumours: real world experience in the low middle income (LMIC) setting

“…Approximately a third of our patients with PMNSGCT underwent surgical resection. There was residual viable tumour in 16.6% of our patients; in contrast to the higher rates described (30%-54.8%) [15][16][17][18][19][20].…”

“…In addition to quantifying response to induction chemo, surgery also helps debulk chemo resistant tumour; especially when this is limited to the mediastinum. Single centre experiences reported from Indiana University and Memorial Sloan Kettering Cancer Center best illustrate the role of post chemotherapy surgery towards improving survival outcomes and cure rates in PMNSGCT including a subset of chemo refractory patients with localised intra-thoracic disease, if their mediastinal primary is resectable [15][16][17][18]. Approximately a third of our patients with PMNSGCT underwent surgical resection.…”

“…Despite improvements in early diagnosis, availability of cisplatin-based chemotherapy, advancements in surgical expertise and SCT, the 5 year OS has not crossed the 60% mark [14-18, 22, 23]. It is also evident that patients undergoing surgical resection have a better outcome when compared to those who did not undergo surgery [17,18].…”

A Rare Case of Primary Mediastinal Endodermal Sinus Tumor Presenting with Hemoptysis

“…Chemotherapeutic regimens usually include cisplatin, etoposide, and bleomycin. While surgical excision was previously not considered due to the assumption of metastasis, however, most recent studies suggest excisional surgery following successful treatment response to cisplatin-based chemotherapy [4,6]. Prognosis of germ cell tumors is based upon AFP levels, location, metastatic diseases, and the ability to have complete surgical resection [6].…”

“…Malignant EGCTs are grouped as either malignant seminomatous tumors (40%) or malignant non-seminomatous tumors (60%) [ 3 ]. ECGTs most commonly occur in the midline of the body and is thought to develop due to the failed migration of primary germ cells during embryogenesis, specifically, with 5-10% of all cases arising in the anterior mediastinum [ 4 , 5 ]. In the non-seminomatous category, yolk sac tumors have the worst prognosis.…”