Abstract
Primary mediastinal germ cell tumor (PMGCT) is rare, and its non-seminomatous subtype (NSGCT) is highly malignant. The mainstay of treatment for PMGCT is systemic chemotherapy, and surgery for a residual tumor is considered in patients with normalized tumor markers. The survival benefit of salvage surgery for persistent positive-marker patients remains unclear. Our purpose was to clarify the role of residual lesion resection in these patients.
A total of 7 patients undergoing surgery for NSGCT in our institution from August 2008 to February 2013 were reviewed. Surgical outcomes of these patients were retrospectively analyzed.
All patients were men and the median age was 25 (range, 18-36) years. The serum alpha-fetoprotein (AFP) level was initially elevated in all patients. All patients received primary chemotherapy consisting of bleomycin, etoposide, and cisplatin with a median cycle number of 4. Four patients additionally received 2nd (n=2), 3rd (n=1), or 4th (n=1) line chemotherapy. The AFP levels did not normalize in 3 patients but decreased to less than 0.5% of the prechemotherapy levels. Complete R0 resection was achieved and AFP levels normalized in all patients.
A pathological complete response was observed in 3 patients. The median 3-year recurrence-free and overall survival rates for all 7 patients were both 86%. The 4 patients with preoperatively normalized AFP levels were alive without recurrence, with a median follow-up period of 56 (range, 26-74) months. Of the 3 persistent AFP-positive patients, 2 were alive without recurrence at 24 and 33 months after surgery.
This study suggests that salvage surgery might be beneficial even for persistent positive-marker patients if the post chemotherapy maker level markedly decreases.
