MEDIASTINAL NONSEMINOMATOUS GERM-CELL TUMORS (MNSGCT) TREATED WITH CISPLATIN-BASED COMBINATION CHEMOTHERAPY

Background. Primary mediastinal non-seminomatous germ cell tumours (MN SGCT) constitute a rare malignancy. This study was performed to review our experience with cispatin-based chemotherapy in patients with MNSG CT. Patients and methods: Patients with MNSGCT treated with cisplatin- based combination chemotherapy between 1978-1995 in three university h ospitals in Spain were retrospectively studied. Results. There were 25 males and two females with a median age of 26 years (range 4-71). Fif teen patients had disease confined to the mediastinum and 12 had metas tatic disease. All patients were treated with cisplatin chemotherapy r egimens (PVB: 7: BEP: 6, and other regimens 12) and considered for res idual mass surgery (RMS) when indicated. Eleven patients (40.7%) were rendered disease-free with initial treatment: four with chemotherapy a lone, one with surgery plus adjuvant chemotherapy and six with chemoth erapy plus RMS. Three of these patients relapsed al two, six and seven months. The remaining 16 had unfavourable reponses (five partial resp onse, three no change, seven progressive disease and one toxic death). Eleven patients received salvage treatment but none of them achieved a durable response. After a 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 series developed a haematological malignancy. Ch romosomal analysis showed that 2 out of 10 patients (20%) had a 47XXY karyotype. Conclusions: Only patients who achieved disease-free status are likely to be cured. Therefore, new up-front strategies are needed for the treatment of MNSGCT.