Resection of primary mediastinal non-seminomatous germ cell tumors: a 28-year experience at memorial sloan-kettering cancer center.

Abstract

INTRODUCTION:

Surgical resection of residual tumor mass in responders to platinum-based chemotherapy has evolved as the preferred treatment of primary mediastinal nonseminomatous germ cell tumors (PMNGCTs). We reviewed a single institution's operative experience with these rare tumors.

METHODS:

We reviewed charts of patients resected for PMNGCT at Memorial Sloan-Kettering Cancer Center between July 1980 and April 2008. Analyses included Kaplan-Meier survival with univariate log-rank comparisons and Cox multivariate regression.

RESULTS:

Fifty-seven patients were identified and followed up for a median of 5.3 years. Fifty-four of them received platinum-based preoperative chemotherapy, and 28 (49%) had limited stage I/II disease. Preoperative tumor markers normalized or decreased in 79% of patients. The most common surgical approach was anterolateral thoracotomy with partial sternotomy ("hemiclamshell," 38.6%). An R0 resection was achieved in 91% of the patients with a major morbidity of 17.5% and no postoperative deaths. The median overall survival was 31.5 months. Factors correlating with better survival on univariate analyses were necrosis or teratoma versus residual cancer on final pathology (p = 0.001), R0 resection (p = 0.03), normalized or decreased postchemotherapy/preoperative tumor markers (p < 0.001), normalized postoperative tumor markers (p = 0.004), stage I/II disease (p = 0.03), and surgery after 2000 versus 1980-1999 (p = 0.01). An exploratory multivariate analysis suggests that normalized or decreased postchemotherapy/preoperative tumor markers is the strongest independent predictor of improved survival.

CONCLUSIONS:

In a cohort of PMNGCT patients in which 91% of the patients underwent complete posttherapy resection, response to chemotherapy, measured by normalized or decreased preoperative tumor markers, was the strongest predictor of improved survival.

• Authors: Inderpal S Sarkaria, Manjit S Bains, Shelly Sood, Camelia S Sima, Victor E Reuter, Raja M Flores, Robert J Motzer, George J Bosl, Valerie W Rusch
• Journal: Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer (J Thorac Oncol) Vol. 6 Issue 7 Pg. 1236-41 (Jul 2011) ISSN: 1556-1380 [Electronic] United States
• PMID: 21610519 (Publication Type: Clinical Trial, Journal Article)

Topics

• Adolescent
• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Bone Neoplasms (drug therapy, secondary, surgery)
• Brain Neoplasms (drug therapy, secondary, surgery)
• Female
• Follow-Up Studies
• Humans
• Liver Neoplasms (drug therapy, secondary, surgery)
• Lung Neoplasms (drug therapy, secondary, surgery)
• Male
• Mediastinal Neoplasms (drug therapy, pathology, surgery)
• Middle Aged
• Neoplasm Recurrence, Local (drug therapy, pathology, surgery)
• Neoplasm Staging
• Neoplasm, Residual (drug therapy, pathology, surgery)
• Neoplasms, Germ Cell and Embryonal (drug therapy, pathology, surgery)
• Retrospective Studies
• Survival Rate
• Teratoma (drug therapy, pathology, surgery)
• Testicular Neoplasms
• Time Factors
• Treatment Outcome
• Young Adult