Abstract
Our strategy for the treatment of primary mediastinal NSGCT includes surgical removal and high dose chemotherapy combined with PBSCT. Ten patients with mediastinal NSGCT were treated in our department. They were 9 males and one female, aged 14-63 years, 3 with embryonal carcinomas, 2 with teratocarcinomas, 1 with yolk sac tumor, 2 with choriocarcinoma and 2 with mixed germ cell tumors. All 10 patients underwent chemotherapy (mainly PVB and VAB-6) and surgery (surgery first in 5 and chemotherapy first in 5). One patient was treated with high dose chemotherapy with PBSCT. Three patients are surviving. One had embryonal carcinomas (139 months), another had choriocarcinoma (74 months) and the other had teratocarcinoma (63 months). The other 7 patients died of the tumor. The median survival period was 22 months. We conclude that NSGCT should be treated mainly with chemotherapy. Surgical therapy is considered to be important for the resection of elements refractory to chemotherapy in tumors with diversity of tissues, for the en blok extirpation of a tumor, and for mediastinal lymph node dissection. Furthermore, it is necessary to devise a strategy for improving the prognosis of this disease which incorporates high dose chemotherapy with PBSCT before the tumor can become resistant to chemotherapy and an operative technique which includes mediastinal dissection.
