GERM-CELL TUMORS OF THE MEDIASTINUM - A 30-YEAR EXPERIENCE

Background. The records of 98 consecutive patients (58 males and 40 fe males; median age, 27 years; age range, 2-64 years) who presented with a primary germ cell tumor (GCT) of the mediastinum between January 19 60 and December 1990 were reviewed. There were 45 mature teratomas, 8 immature teratomas, 16 pure seminomas, and 24 malignant nonseminomatou s GCT (MNSGCT). Results. All patients with mature teratomas were cured by radical resection alone, except one patient who died intraoperativ ely. Among the eight patients with immature teratomas, five were treat ed before the advent of cisplatin treatment (two children younger than 15 years were cured by surgery alone and three adults died within 7 m onths after operation). Three patients underwent surgery followed by c isplatin-based chemotherapy (two are still alive and one died of an as sociated rhabdomyosarcoma). Thirteen of 16 patients with seminomas (81 %) were cured by surgery either alone (5 patients) or with adjuvant ra diation therapy (8 patients). Among the 24 MNSGCT, 10 were treated bef ore 1980 without cisplatin and all but 1 died of disease progression. Fourteen patients were treated by initial high-dose cisplatin combinat ion chemotherapy and 8 (57%) achieved complete remission (2 died of sy stemic mastocytosis development). Conclusions. Results indicate the be nignity of mature teratomas of the mediastinum, the age-dependent clin ical course of immature teratomas, and the excellent prognosis of semi nomas. The improved survival advantage resulting from cisplatin-based chemotherapy in MNSGCT is impaired by the propensity to nongerminal so lid tumor development and hematologic malignancies.