Mediastinal non-seminomatous germ cell tumours (MNSGCT) treated with cisplatin-based combination chemotherapy

Background: Primary mediastinal non-seminomatous germ cell tumours (MNSGCT)constitute a rare malignancy. This study was performed to review ourexperience with cispatin-based chemotherapy in patients with MNSGCT.Patients and methods: Patients with MNSGCT treated with cisplatin-basedcombination chemotherapy between 1978–1995 in three university hospitalsin Spain were retrospectively studied.Results: There were 25 males and two females with a median age of 26 years(range 4–71). Fifteen patients had disease confined to the mediastinumand 12 had metastatic disease. All patients were treated with cisplatinchemotherapy regimens (PVB: 7, BEP: 6, and other regimens 12) and consideredfor residual mass surgery (RMS) when indicated. Eleven patients (40.7%)were rendered disease-free with initial treatment: four with chemotherapyalone, one with surgery plus adjuvant chemotherapy and six with chemotherapyplus RMS. Three of these patients relapsed at two, six and seven months. Theremaining 16 had unfavourable reponses (five partial response, three nochange, seven progressive disease and one toxic death) . Eleven patientsreceived salvage treatment but none of them achieved a durable response. Aftera median follow-up of 77 months (range 1–168), 10 patients remain alive.Actuarial survival at five years is 31.7%. No patients in this seriesdeveloped a haematological malignancy. Chromosomal analysis showed that 2 outof 10 patients (20%) had a 47XXY karyotype.Conclusions: Only patients who achieved disease-free status are likely tobe cured. Therefore, new up-front strategies are needed for the treatment ofMNSGCT.