Treatment strategies and prognostic factors of patients with primary germ cell tumors in the mediastinum

Abstract

ObjectiveThe aim of this study was to evaluate the clinical characteristics and survival outcomes of patients with primary mediastinal germ cell tumor (PMGCT) by identifying the prognostic factors and efficacies of different treatment modalities.MethodsFifty-five patients with PMGCT who were treated consecutively at Cancer Center, Sun Yat-sen University, Guangzhou, from 1988 to 2010 were evaluated retrospectively.ResultsFifty-two men and 3 women with a median age of 25 years were identified, of whom 17 (30.9%) had pure seminomatous, 38 (69.1%) had nonseminomatous histology, 27 (49.1%) had tumor located at mediastinum, 20 (36.4%) had lung metastases and/or effusions, and 8 (14.5%) had distant metastases. Three treatments surgery, chemotherapy, and radiotherapy were performed in 11 (20%) patients, two treatments chemotherapy plus surgery or radiotherapy were performed in 25 (45.6%), and single treatment surgery or chemotherapy was performed in 17 (30.9%). The other two patients (3.6%) received no treatment. After a median follow-up time of 31.4 months, the 5-year survival rate was 52%. The median overall survival time was 87.9 months. Patients who received two treatments had the longest survival time of 118.3 months, P = 0.000. Those who had pure seminoma histology, whose tumor confined to the mediastinum and who achieved complete or partial remission at initial evaluation, who had complete resection and radiotherapy were considered to have better prognosis according to univariate analysis. On multivariate analysis, extension and response rate at initial evaluation were independently predictive of survival.ConclusionsPrimary mediastinal germ cell tumor is rare with a dominant frequency in young male patients. Chemotherapy combined with local therapy like surgery or radiotherapy is a reasonable treatment strategy recommended. Extension and initial remission rate are independent prognostic factors.

A Case of Mediastinal Seminoma Presenting as Superior Vena Cava Syndrome

“…Considering that single cisplatin-based chemotherapy is incapable of eliminating the residual tumor or micrometastases due to the extensive properties of germ cell tumors in the mediastinum (21), we added radiotherapy at the basic level of cisplatin-based regimens and noted a striking reduction in size of the tumor at the end of irradiation. At last, the curative effect of the present patient is remarkable, and the prognosis is favourable, which was in accord with previous reports (21,23,24).…”

“…Patients who received two treatments of chemotherapy plus surgery or radiotherapy had the longest survival time of 118.3 months compared with the median overall survival time of 87.9 months (p=0.000). They recommended that chemotherapy combined with a local therapy such as surgery or radiotherapy is a reasonable treatment strategy (21). It was reported that cisplatin-based chemotherapy is curative for the vast majority of patients with mediastinal seminoma (22).…”

Anterior mediastinal solid tumours in adults: characterisation using dynamic contrast-enhanced MRI, diffusion-weighted MRI, and FDG-PET/CT

“…In addition, seminomas and nonseminomatous malignant germ cell tumours are generally treated with chemotherapy before surgery. 9,10 Thymic epithelial tumours are usually treated with surgery even if they have invaded surrounding structures and have pleural disseminations. 11 Therefore, the differential diagnosis of anterior mediastinal solid tumours has a clinical impact for physicians.…”

Intensity modulated radiation therapy to treat primary female mediastinal seminoma and massive pericardial effusion: A case report

“…The chemotherapeutic effect varies between men with primary mediastinal seminoma (9). Another explanation is that the patient was diagnosed with mediastinal seminoma through biopsy.…”