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Ann Thorac Surg 1987;44:578-582
© 1987 The Society of Thoracic Surgeons

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Articles

A Multidisciplinary Approach to Primary Nonseminomatous Germ Cell Tumors of the Mediastinum

From Brompton Hospital, London, England

Accepted for publication March 30, 1987.

^* Address reprint requests to Mr. Goldstraw, Brompton Hospital, Fulham Rd, London, England SW3 6HP

The introduction of cis-platinum-based chemotherapy has dramatically improved the prognosis for patients with primary nonseminomatous germ cell tumors of the mediastinum. Since 1978, 12 male patients (mean age, 29 years) have been seen with a large mediastinal mass, normal testes, and abnormal testicular tumor markers. Eleven patients had raised α-fetoprotein levels (median, 1,300 (µg/L; normal, less than 10 µg/L), and 3 had elevated levels of the beta fraction of human chorionic gonadotropin (median, 8,000 IU/L; normal, less than 5 IU/ L). Two patients were treated by primary surgical intervention followed by chemotherapy. Ten patients were treated with primary chemotherapy (cis-platinum, vinblastine sulfate or etoposide, and bleomycin sulfate), and this was followed by timed surgical excision of the tumor mass in 7. Six (60%) patients responded to primary chemotherapy with normalization of tumor markers. In this group there was 1 postoperative death and 1 recurrence. The 4 remaining patients are alive and free from disease at a mean of five years. Of the 4 patients with persistently elevated tumor markers, 2 died within six months, 1 is alive with recurrence, and 1 is lost to follow-up at three months. Patients whose tumor markers return to normal after cis-platinum-based chemotherapy have a good long-term prognosis following radical surgery. If the tumor markers remain elevated, the prognosis is poor.

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