Platinum-based chemotherapy of primary extragonadal germ cell tumours: the Hellenic Cooperative Oncology Group experience.

Extragonadal germ cell tumours (EGCT) are uncommon, most frequently arise in the mediastinum and retroperitoneum and have variable responses to platinum-based chemotherapy. A retrospective analysis was performed on 38 patients with EGCT treated with cisplatin-based (CDDP) or carboplatin-based (CBDCA) chemotherapy between 1984 and 1998. Twenty-four patients had nonseminomatous germ cell tumours (NSGCT) and 14 seminoma. Twenty-two tumours arose in the mediastinum (13 nonseminomas, 9 seminomas) and 16 in the retroperitoneum (11 NSGCT, 5 seminomas). Initial surgery included complete resection in 1 patient, biopsy in 27 patients and debulking surgery in 10 patients. Complete response rates with chemotherapy +/- surgery were as follows: mediastinum 14 of 21 (66.66%) patients (8 of 12-75% NSGCT, 6 of 9-66.66% seminomas) and retroperitoneum 14 of 16 (87.5%) patients (9 of 11-81.81% NSGCT, 5 of 5-100% seminomas). One patient who underwent complete resection of a mediastinal malignant teratoma combined, received PVB chemotherapy on an adjuvant basis and remains alive and disease-free. Three additional seminoma patients who achieved partial response after chemotherapy remain alive and disease-free following mediastinal radiotherapy. All 14 patients with extragonadal seminomas remain alive with no evidence of disease at a median follow-up of 49 months (range 7-164), giving an overall survival of 100%. Nine of 13 (69.23%) patients with mediastinal NSGCT are long-term disease-free at a median follow-up of 43.5 months (range 7-152). Nine of 11 (81.81%) patients with retroperitoneal NSGCT remain alive and disease-free at a median follow-up of 56 months (range 14-110). Complete surgical resection of residual mass was undertaken in 10 patients (3 seminomas, 7 nonseminomas). The histology revealed necrosis/fibrosis in 6 patients (3 seminomas, 3 NSGCT) and viable cancer in 4 patients. Patients who had viable malignant cells in the resected specimens received two more courses of VelP chemotherapy. None of our patients had relapsed at the time of this analysis. None of our 6 patients who underwent testicular biopsy (1 patient) or orchiectomy (5 patients) due to suspicious ultrasound of the testis were found to have testicular tumour or fibrotic scar. In conclusion, this retrospective analysis showed significant responses in patients with either mediastinal or retroperitoneal NSGCT treated with CDDP- or CBDCA-based chemotherapy +/- surgery. All patients with extragonadal seminomas remain alive with no evidence of disease, regardless of the site at presentation.     

Primary Malignant Germ Cell Tumours of the Mediastinum: Results of Multimodality Treatment

Primary malignant mediastinal germ cell tumours are rare and considered to have poorer prognosis compared with those arising from gonads. Eighteen patients with primary mediastinal germ cell tumour were treated over an 11-year period; 9 had seminoma and 9 non-seminoma. Eight patients, 4 each with seminoma and non-seminoma underwent initial tumour excision and the rest had biopsy only. All patients received cisplatin-based chemotherapy. All patients with seminoma received consolidation radiotherapy to mediastinum. Three patients with non-seminoma received radiotherapy following partial response. All 9 patients with seminoma achieved complete response at the end of chemotherapy. Two patients with NSGCT had complete response to chemotherapy, 5 partial response and 2 no response. Two patients who underwent resection of the residual tumour mass are surviving free of disease. Addition of radiotherapy or second-line chemotherapy did not bring about any added response in partial and non-responders. Nine out of 9 patients with seminoma and 4/9 with non-seminoma are surviving disease-free at a median follow-up of 48 months (range 16-153 months). Mediastinal seminoma has excellent prognosis with cisplatin combination chemotherapy, whereas non-seminoma carries poor prognosis, and aggressive chemotherapy with resection of residual masses may improve the outcome. The role of additional radiotherapy and initial tumour debulking needs further evaluation.     

Extragonadal germ cell tumors in Taiwan: an analysis of treatment results of 59 patients

BACKGROUND: Extragonadal germ cell tumors (EGCT) are rare. They are biologically distinct from their testicular counterparts. Information regarding these tumors from the Far East is limited. More investigations are warranted to define the optimal treatment. METHODS: Retrospective review of the medical records of 59 patients with EGCT treated between 1983 and 2001 at a large, tertiary care institute in Taipei. RESULTS: The study population comprised 54 males and 5 females, ranging in age from 1 to 68 years old (median age, 21 years). Primary tumors occurred in the mediastinum (n = 27), retroperitoneum (n = 6), central nervous system (CNS; n = 24), and other sites (n = 2). Patients received surgery, chemotherapy, radiotherapy, or a combination of treatment modalities as the primary treatment. Three patients with mediastinal seminoma achieved complete remission (CR) and are alive with no evidence of disease (NED), with a median follow-up of 118 months. Of 24 patients with mediastinal nonseminomas, 8 (33%) are alive with a median disease-free survival (DFS) period of 33 months. Two of six patients with retroperitoneal nonseminomas obtained CR and are alive with NED at 41 and 110 months, respectively. Of 24 patients with intracranial germ cell tumors, 16 had germinoma and 13 (81%) achieved CR with NED at 8-228 months (median duration, 104 months). Four of eight patients with CNS nongerminomas remain in CR and are alive with a median DFS period of 48 months. Four patients with mediastinal nonsemonimas treated with salvage chemotherapy died. CONCLUSIONS: The treatment results of our patients with seminomatous EGCT are comparable to those of Western countries. However, the treatment results of patients with nonseminomatous EGCT are not as good. The reason for this discrepancy needs to be explored for a better treatment outcome of for patients in Taiwan with EGCT.     

Extragonadal germ cell tumors of the mediastinum and retroperitoneum: results from an international analysis.

PURPOSE: To characterize the clinical and biologic features of extragonadal germ cell tumor (EGCT) and to determine the overall outcome with currently available treatment strategies. PATIENTS AND METHODS: Of an unselected population of 635 consecutive patients treated from 1975 through 1996 at 11 cancer centers, 341 patients (54%) had primary mediastinal EGCT, and 283 patients (45%) had retroperitoneal EGCT. Five hundred twenty-four patients (83%) had a nonseminomatous germ cell tumor (GCT), and 104 patients (16%) had a seminomatous histology. RESULTS: After platinum-based induction chemotherapy with or without secondary surgery, 141 patients (49%) with mediastinal nonseminomas (median follow-up, 19 months; range, 1 to 178 months) and 144 patients (63%) with retroperitoneal nonseminoma (median follow-up, 29 months; range, 1 to 203 months) are alive (P =.0006). In contrast, the overall survival rate for patients with a seminomatous EGCT is 88%, with no difference between patients with mediastinal or retroperitoneal tumor location (median follow-up, 49 months; range, 4 to 193 months; respective 70 months; range, 1 to 211 months). A significantly lower progression-free survival rate was found in seminoma patients treated with initial radiotherapy alone compared with chemotherapy. Nonseminomatous histology, presence of nonpulmonary visceral metastases, primary mediastinal GCT location, and elevated beta-human chorionic gonadotropin were independent prognostic factors for shorter survival. Hematologic malignancies (n = 17) occurred without exception in patients with primary mediastinal nonseminoma. Sixteen patients developed a metachronous testicular cancer despite the use of platinum-based chemotherapy. CONCLUSION: Whereas patients with pure seminomatous EGCT histology have a long-term chance of cure of almost 90% irrespective of the primary tumor site, 45% of patients with mediastinal nonseminomas are alive at 5 years. This outcome is clearly inferior compared with patients with nonseminomatous retroperitoneal primary tumors.     

Chemotherapy of extragonadal germ cell tumors

Forty-nine patients with histologically proven germ cell tumors arising in extragonadal sites were retrospectively reviewed. Included in the review were an additional seven patients with undifferentiated tumors with a pathologic appearance compatible with that of a germ cell tumor and elevated levels of serum biomarkers (beta subunit of human chorionic gonadotropin [beta-HCG] +/- alpha-fetoprotein [AFP]. Nineteen patients had a pure seminoma arising in an extragonadal site, whereas 30 patients had nonseminomatous germ cell tumors. Seven patients had primary undifferentiated tumors with elevated levels of serum biomarkers. Sixteen (84%) of the 19 patients with pure extragonadal seminomas with normal levels of serum AFP are alive and free of disease. Eighteen of these 19 patients received platinum-containing regimens and four had received prior chemotherapy that failed. Of the patients with nonseminomatous germ cell tumors, 12 (40%) of the 30 are alive and free of disease with vinblastine/bleomycin +/- cisplatin (13 patients) or CISCAII (cisplatin, cyclophosphamide, and doxorubicin) (nine patients) alternating CISCAII/VBIV (eight patients) chemotherapy. None of the seven patients with undifferentiated germ cell tumors are alive and free of disease. Three of the five patients with pure anterior mediastinal endodermal sinus tumors treated with chemotherapy remain alive and free of disease. Of the seven patients with choriocarcinomas arising in extragonadal sites, three are alive and free of disease. A classification for patients with extragonadal germ cell tumors incorporating site of origin, histology, and likelihood of being truly extragonadal is proposed. The implications of this classification are discussed.     

Extragonadal seminoma: an international multicenter analysis of prognostic factors and long term treatment outcome

BACKGROUND: The objectives of this study were to evaluate the long term outcome of patients with extragonadal seminomatous germ cell tumors (GCT) so that prognostic variables for disease recurrence and patient survival could be identified and to access the efficacy of different treatment modalities. METHODS: Six hundred thirty-five patients with extragonadal GCT who were treated consecutively at 11 centers in the United States and Europe during the cisplatin-based chemotherapy era between 1975 and 1996 were evaluated retrospectively. RESULTS: Fifty-two patients with primary retroperitoneal GCT (50%) and 51 patients with primary mediastinal GCT (49%) of pure seminomatous histology were identified (n = 1 patient with a primary cervical lymph node) representing 16.4% of 635 patients with extragonadal GCT who were included in the data base. The median age was 37 years (range, 18-70 years). Treatment consisted of platin-based chemotherapy in 77 patients (74%), radiotherapy in 9 patients (9%), and combined modality in 18 patients (17%). Ninety-two percent of patients (95% confidence interval, 87-97%) achieved a favorable response to primary therapy. After a median follow-up of 61 months (range, 1-211 months), 18 patients (17%) have had recurrent disease: 14% of those who received chemotherapy and 67% of those who received radiation therapy. The 5-year progression free survival rate favored the chemotherapy group, with 87% compared with 33% for irradiated patients (P = 0.006), whereas the overall survival rates were equal (90% vs. 67%; P = 0.13). No differences in overall survival or progression free survival were observed among patients with primary retroperitoneal and mediastinal seminoma. Prognostic factors that were identified to influence survival negatively were liver metastases (P = 0.01) and two or more metastatic sites (P = 0.04). CONCLUSIONS: In patients with extragonadal seminoma, a survival rate of > 90% at 5 years is achieved with adequate cisplatin-based chemotherapy. Compared with patients with nonseminomatous extragonadal GCT, no difference in long term survival exists between patients with primary retroperitoneal or mediastinal seminoma location. Primary radiotherapy seems to be associated with a significantly higher rate of disease recurrence, although most patients will be salvaged by subsequent chemotherapy.     

Cisplatin combination chemotherapy in advanced seminoma

Thirty-one patients were treated with cisplatin combination chemotherapy for advanced seminoma (26 Stage III or bulky Stage II testicular, and five disseminated extragonadal). Seventeen (89%) of 19 patients not previously pretreated and four (80%) of five who had received only abdominal irradiation entered continuous complete remission (CR), versus only two (28%) of seven patients who had received extensive infra- and supradiaphragmatic radiotherapy. Results were not significantly influenced by stage, human chorionic gonadotropin (HCG) titers and histologic subgroups, whereas patients with lactic dehydrogenase (LDH) values exceeding 500 mIU/ml did worse (50% continuous CR rate in 12 cases) than those with normal or less elevated titers (89% continuous CR rate in 19 cases). After a median follow-up period of 34 months (range, 12+ to 77+ months), 23 patients (74.5%) remain alive in continuous CR, two (6%) died in CR and another one (3%) entered CR after deferred treatment of residual disease. Five patients (16%) died of cancer. Toxicity was severe in extensively irradiated patients, but it was acceptable in those not pretreated and in those who had received only subdiaphragmatic radiotherapy. Cisplatin combination chemotherapy can be successfully and safely used as the primary treatment of choice in patients with advanced seminoma. It is also an excellent salvage therapy for patients who had received subdiaphragmatic irradiation only. On the contrary, it is very difficult to treat with chemotherapy extensively irradiated patients.     

VAB-6 and cisplatin-cyclophosphamide combinations in the treatment of metastatic seminoma patients: the U.S.S.R. experience.

In a non-randomized study the treatment results of 59 patients with disseminated seminoma were evaluated: 21 patients were treated with a VAB-6 combination and 38 with a CP (cyclophosphamide and cisplatin) combination. After VAB-6 CR was observed in 8 patients and 6 achieved CR with additional treatment: 1 with chemotherapy (PVB) and 5 with radiotherapy (RT). The final CR rate was 67%. At a median follow-up of 38 (11-70) months 15 (71%) are alive, and 11 of them (52%) are NED; 6 have died. Of the 38 patients treated with CP alone only 18 achieved CR and 9 had a CR after additional RT and 1 chemotherapy (VAB-6), the overall CR rate was 72%. The median follow-up is 24 (4-55) months, 28 (74%) are alive, 24 (66%) are currently NED, and 9 have died. Both regimens were well tolerated, the main toxicity being leukopenia: 48% (WHO grade 111-1V-5%) for VAB-6, and 59% (13%) for CP. Hearing loss was registered in 8 patients receiving CP and in 2 receiving VAB-6. There were no fatal toxicities. Thus, VAB-6 and CP regimens seem to have compatible and high activity in disseminated seminoma.     

原发于纵隔的生殖细胞肿瘤47例临床分析

目的探讨原发于纵隔的生殖细胞肿瘤的临床特点、治疗方法及预后的影响因素。方法回顾性分析47例原发于纵隔的生殖细胞肿瘤患者的临床资料。结果47例患者中,男性41例,女性6例,中位年龄26岁;8例（17．0％）精原细胞瘤,39例（83．0％）非精原细胞瘤。全组患者中位生存期为16个月,1、3、5年生存率分别为63．4％、37．5％和34．8％;非精原细胞瘤患者1、3、5年生存率分别为56．4％、30．0％和27．3％,8例精原细胞瘤患者中,7例生存满5年。多因素分析显示,病理类型是原发于纵隔的生殖细胞肿瘤患者预后的独立影响因素（P=0．045）。结论纵隔精原细胞瘤患者对放疗、化疗敏感,预后较好;纵隔非精原细胞瘤患者预后差,化疗是其主要治疗手段,以顺铂为基础的化疗明显提高了这类患者的生存率。     

Primary mediastinal nonseminomatous germ cell tumors. A modern single institution experience.

Between 1976 and 1988, 31 patients with mediastinal nonseminomatous germ cell tumors (MNGCT) received initial cisplatin-based chemotherapy of uniform intensity. Eighteen of these patients (58%) obtained disease-free status; 11 with chemotherapy alone and seven with adjunctive surgery. Eleven have remained continuously free of disease. Two have had recurrence of teratoma and are disease-free after resection of teratoma at 12+ and 68+ months. Three patients developed recurrence of germ cell tumor. Three patients developed a hematologic malignancy. Of the 18 patients who obtained disease-free status, 15 remain alive and disease-free. Overall, 13 of the 31 patients and 24 other patients received salvage chemotherapy at Indiana University, Indianapolis, Indiana. Of these 37 patients, six obtained a disease-free status and four (11%) remain alive at 13+, 56+, 78+, and 122+ months, respectively. This series represents the largest series of patients with MNGCT ever reported. Analysis of these data and results from other recent series suggest that approximately 50% of patients with MNGCT will be cured with modern, intense cisplatin-based chemotherapy coupled with adjunctive surgery if needed.     

Combined 5-fluorouracil (5-FU) and radiation therapy following resection of locally advanced gastric carcinoma

Twenty-five patients with locally advanced but resectable adenocarcinoma of the stomach were given concomitant postoperative radiotherapy to the tumor bed and chemotherapy with 5-Fluorouracil (5-FU). Twenty-two of the patients had regional lymph node involvement and seven had residual tumor in the surgical margins. Radiotherapy was delivered to a total dose of 5,000 rads in 7 weeks with a two-week split. 5-FU was given daily the first 3 days of each treatment period and was then continued weekly for a minimum of 1 year. At a median follow-up time of 19 months, 11 patients have relapsed, two locally and nine distally, and all have died. Thirteen patients remain alive, all but one disease-free, for a median of 21 months from diagnosis. One additional patient died of unrelated causes, free of tumor. The actuarial median survival for the whole group stands at 33 months with a projected 5-year survival of 40%. Treatment has been well tolerated.     

Multimodality treatment of malignant germ cell tumours of the mediastinum

Of 15 patients with malignant germ cell tumours of the mediastinum, 9 patients had pure seminomas and 6 had non-seminomas. Resection was radical in only 4 non-seminomas, 1 of which was resected after chemotherapy; radiotherapy was delivered to all seminoma patients as sole therapy (2 patients) or as part of combined modality therapy. All patients with non-seminomatous tumours underwent chemotherapy (cisplatin-based combination). Therapy was generally well tolerated, but 1 seminoma patient died of sepsis. Chemotherapy achieved a 71% complete response rate in pure seminoma patients and a 33% complete response rate in non-seminoma patients. 53% of patients are alive and free of disease beyond 36 months from start of any treatment. Pure seminoma patients survived longer than non-seminoma patients (3 and 5 year survivals were 67% and 33%, respectively). Although cisplatin-based chemotherapy is highly effective in pure seminomas and also in non-seminomas, a better therapeutic approach is needed in non-seminomas.     

Testicular seminoma stage I: Treatment results and long-term follow-up (1968–1988)

Sixty-nine patients with stage I testicular seminoma were referred to the Northern Israel Oncology Center between 1968 and 1987. Sixty-four patients were irradiated postoperatively and five patients had surveillance alone. Complete follow-up was available for all patients, with a median follow-up of 86 months (range 9–239 months). The last follow-up was in December 1988. Actuarial survival was 94% to 5, 10, 15, and 20 years. Six patients relapsed following completion of irradiation. All the recurrences occurred outside the radiation field. Three of the relapsed patients could be salvaged with cisplatinum-based chemotherapy and are alive at 4, 7, and 10 years following second-line treatment. Acute or chronic side effects were mild and manageable. Seven patients developed second primary cancers, two within and six outside the radiation field. While surveillance policy alone in stage I testicular seminoma may be successful in terms of patient outcome, it requires prolonged observation, good compliance of patients, and intensive use of resources. Thus, until proved otherwise, infradiaphragmatic radiotherapy should further remain the optimal routine treatment in seminoma patients with stage I disease. © 1993 Wiley-Liss, Inc.     

The results of chemotherapy for extragonadal germ-cell tumors in the cisplatin era: the Memorial Sloan-Kettering Cancer Center experience (1975 to 1982)

Thirty-eight patients with extragonadal germ-cell tumors treated at Memorial Sloan-Kettering Cancer Center (New York) between 1975 and 1982 received high-dose cisplatin-based chemotherapy. Complete response was achieved in 89% of patients with pure seminoma and all complete responders are alive without evidence of disease (median follow-up time, 29+ months). Complete response was achieved in only 41% (12 of 29) of patients with extragonadal nonseminomatous germ-cell tumors; only four patients are alive and free of disease (median survival time, 18 months). Although patients with extragonadal seminoma respond well with current cisplatin-based chemotherapy, minimal improvement in CR rates has been achieved in patients with extragonadal nonseminomatous tumors. Patients with extragonadal nonseminomatous germ-cell tumors have a relatively poor prognosis when compared to patients with primary testicular tumors and investigational trials of innovative therapy should be considered.     

A 20-year review of haemangiopericytoma in Auckland, New Zealand

The records of all patients registered with a histological diagnosis of haemangiopericytoma in Auckland between 1970 and 1990 were reviewed retrospectively, with the aim of determining the natural history of the disease and the response to various treatment modalities. A total of 24 patients were identified, having a median age of 45 years.Twenty-one patients (87.5%) underwent surgery; the remaining three were deemed to be unfit for surgery. Seven patients (29%) were treated with surgery alone; nine (37.5%) received a radical course of radiotherapy and three (12.5%) received palliative radiation therapy for pain relief and/or dyspnoea. Five patients (21%) received chemotherapy during the course of their disease.Eight of the 24 patients (33%) were alive and disease free, 13 (54%) having died and three (13%) being lost to follow-up. Seven patients (29%) died as a result of metastatic disease. Three of the seven (43%) who were treated with surgery alone are known to be alive and disease free. The three patients who had received palliative radiotherapy, died within 2 months of completing the latter treatment. Five of the nine patients (56%) receiving a course of radical radiotherapy are alive and disease free at present. No local recurrence was noted following surgical excision and postoperative radical radiotherapy, whilst eight (67%) of those initially treated by excision alone developed recurrent disease. None of the patients treated with chemotherapy obtained significant palliation.Results suggest that adequate surgical excision followed by postoperative radiotherapy is effective in controlling haemangiopericytoma and that metastatic disease is at present invariably fatal. The role of chemotherapy needs further investigation.     

Therapeutic guidelines and results in advanced seminoma

Twenty patients with advanced seminoma were treated with chemotherapy. Fourteen patients were previously untreated (group 1) and received vinblastine, bleomycin, and cisplatin (VPB) at presentation. Six patients had received prior radiation therapy (group 2), and at relapse received either VPB or VP-16-213 (etoposide)-cisplatin. Within group 1, five patients received no further therapy after VPB (group 1A), six patients received radiation to residual radiographic abnormalities (group 1B), and three patients underwent surgery to remove residual radiographic areas following VPB (group 1C). The complete response rate in group 1 was 14/14 (100%). At present within group 1A, 5/5 patients (100%) are alive and disease-free (NED) for a median follow-up of 32 + months. In group 1B, 6/6 patients (100%) are alive and NED for a median follow-up of 17+ months. In group 1C, 3/3 patients (100%) had residual fibrosis at the time of surgical resection. Two of these patients died of postoperative complications with no evidence of disease and the third is alive and NED at 19+ months. In group 2, 4/6 patients (67%) achieved a complete remission, including two patients who are NED at 22+ and 85+ months, respectively. Two have died and two are alive with progressive disease. Doses of chemotherapy to group 2 patients were substantially lower than the doses given to group 1 patients. We conclude that chemotherapy is acceptable initial therapy for advanced seminoma, and prior extensive radiation therapy may impair the ability to give adequate doses of chemotherapy in patients who relapse. Residual masses after chemotherapy are often fibrotic and the role of postchemotherapy radiation therapy in these patients is uncertain.     

Management of primary malignant germ cell tumor of the mediastinum

BACKGROUND: Primary mediastinal malignant germ cell tumors (GCTs) are rare and have a worse prognosis than their gonadal counterparts. Although multimodality treatment is a standard therapeutic strategy in mediastinal GCTs, the clinical implications of surgical intervention remain unclear. METHODS: Forty-eight patients with primary mediastinal malignant GCT who were treated at the National Cancer Center Hospital, Tokyo, from 1962 to 2002 were studied retrospectively with regard to their histology and clinical profile. RESULTS: Mediastinal GCT occurred predominantly in young males, with a mean age of 28.8 years at the time of diagnosis. There were 46 males (96%) and two females (4%). Histologically, seven patients (15%) were diagnosed as having pure seminoma and 41 (85%) had non-seminomatous GCT. Treatment consisted of surgery alone in nine patients, surgery followed by chemotherapy in two, and chemotherapy followed by surgery in 20. The other 17 patients received chemotherapy and/or radiotherapy without surgery. Of these latter 17 patients, 14 developed progressive disease and three were followed up with a sustained partial response. Among the 31 patients who underwent surgery, complete resection was performed in 27 (87%) and incomplete resection was performed in four (13%). Twelve (41%) patients had elevated serum tumor marker levels preoperatively. Among the 20 patients who received preoperative chemotherapy, viable cells were found in the resected specimen in six (30%). With regard to tumor recurrence in patients with surgical intervention, the preoperative serum tumor marker levels and the presence of viable cells in the resected specimen were significantly associated with recurrence. There was no significant association between surgical curability and recurrence. The 5-year overall survival rate in all 48 patients was 45.5%. CONCLUSIONS: Surgical intervention for mediastinal GCT may be needed to remove a chemotherapy-refractory tumor or to assess the pathological response to chemotherapy to determine the indications for further chemotherapy.     

Sequential multi-agent chemotherapy and whole abdominal irradiation for stage III ovarian carcinoma

Modern therapy for stage III ovarian carcinoma patients usually involves one or more laparotomies with maximal resection of tumor, and intensive multi-agent chemotherapy. However, with long-term follow-up only 10-15% of patients remain free of disease. In the hope of improving outcome, we have treated 17 women with sequential multimodality therapy, including initial surgical resection (if possible), cyclophosphamide-adriamycin +/- cis-platinum, second-look surgery, and whole abdominal irradiation. Seven patients are currently alive without disease, with median follow-up of 52 months since initiation of radiation and 60 months since initiation of chemotherapy. Disease-free survival correlated with residual tumor at the start of radiotherapy: none (4/4); microscopic, less than or equal to 5 mm (3/4); greater than 5 mm or no surgery (0/9). Survival also correlated with tumor grade: grade 1 (2/2); grade 2 (2/3); grade 3 (3/11). Hematological tolerance of radiotherapy was dependent upon the number of chemotherapy cycles: ten of 11 patients receiving less than or equal to eight cycles completed radiotherapy without excessive delay, compared with only one of five receiving greater than eight cycles. There were no treatment-related deaths and only one patient required laparotomy for bowel obstruction. We conclude that intensive multimodal treatment may be tolerated moderately well if the amount of chemotherapy is limited, and that further studies are justified.     

原发性纵隔精原细胞瘤──附3例报告并文献复习

原发性纵隔精原细胞瘤罕见，本文报告３例，均经组织病理学证实。２例接受手术及术后放疗和化疗，１例单纯化疗，平均随访３．７年（分别为２年、４年、５年），１例死亡，２例仍存活。本文结合文献对此病的组织发生、临床特征、诊断、治疗原则及预后等进行了讨论．