Germ cell tumors of the mediastinum. A 30-year experience

Abstract

Background. The records of 98 consecutive patients (58 males and 40 females; median age, 27 years; age range, 2-64 years) who presented with a primary germ cell tumor (GCT) of the mediastinum between January 1960 and December 1990 were reviewed. There were 45 mature teratomas, 8 immature teratomas, 16 pure seminomas, and 24 malignant nonseminomatous GCT (MNSGCT).Results. All patients with mature teratomas were cured by radical resection alone, except one patient who died intraoperatively. Among the eight patients with immature teratomas, five were treated before the advent of cisplatin treatment (two children younger than 15 years were cured by surgery alone and three adults died within 7 months after operation). Three patients underwent surgery followed by cisplatin-based chemotherapy (two are still alive and one died of an associated rhabdomyosarcoma). Thirteen of 16 patients with seminomas (81%) were cured by surgery either alone (5 patients) or with adjuvant radiation therapy (8 patients). Among the 24 MNSGCT, 10 were treated before 1980 without cisplatin and all but 1 died of disease progression. Fourteen patients were treated by initial high-dose cisplatin combination chemotherapy and 8 (57%) achieved complete remission (2 died of systemic mastocytosis development).Conclusions. Results indicate the benignity of mature teratomas of the mediastinum, the age-dependent clinical course of immature teratomas, and the excellent prognosis of seminomas. The improved survival advantage resulting from cisplatin-based chemotherapy in MNSGCT is impaired by the propensity to nongerminal solid tumor development and hematologic malignancies.

Primary germ cell tumors in the mediastinum

“…As for benign teratomas, a female predominance (a 1.64:1 ratio). This was comparable with the female predominance (a 1.27:1 ratio) reported by Lewis et al 7 and Dulmet et al 9 (a 2.05:1 ratio). Clinical symptoms and physical examination contributed little to making a diagnosis.…”

“…A VATS excision should be used for relatively small tumors that do not severely adhere to the adjacent tissues. Dulmet et al 9 reported that immature teratomas comprised 8 of 98 GCT cases. These patients were given additional chemotherapy and/or irradiation.…”

“…Primary or adjuvant radiation for mediastinal seminomas have been effective in the local control of the tumors. 9,14,17 Three patients received postoperative radiation, resulting in long-term survival. However, disease recurred in the lung field or distant sites that were not included in the radiation field.…”

“…Economou et al 15 reported that the median survival for patients not treated with cisplatin was 4.0 months compared with 14.0 months for patients treated with cisplatin-based postoperative chemotherapy. Dulmet et al 9 reported that 8 of 10 patients died within 1 year, with a median survival of 6.5 months. In our series of 11 patients with NSGCT who were not treated with cisplatin, the longest survival was 13 months with a median survival of 5.7 months.…”

First-line sequential high-dose VIP chemotherapy with autologous transplantation for patients with primary mediastinal nonseminomatous germ cell tumours: a prospective trial

“…Such patients appear to represent a clinically and biologically distinct disease entity (Nichols et al, 1985(Nichols et al, , 1987(Nichols et al, , 1990aHartmann et al, 2000b, (Saxman et al, 1994, Loehrer et al, 1998Hartmann et al, 2001a). Historically, the incorporation of cisplatin into chemotherapy regimens has yielded survival rates of approximately 30 -40% in retrospective analyses (Garnick et al, 1983;Logothetis et al, 1985;Delgado et al, 1993;Dulmet et al, 1993;Toner et al, 1991; International germ cell consensus classification, 1997). Two prospective series based on 31 and 41 patients reported a long-term survival rate of 450% following conventional cisplatin-based chemotherapy plus secondary surgery (Nichols et al, 1990b, Bukowski et al, 1993.…”