Annals of Oncology Advance Access published online on November 4, 2009
Annals of Oncology, doi:10.1093/annonc/mdp516
Outcome following resection for patients with primary mediastinal nonseminomatous germ-cell tumors and rising serum tumor markers post-chemotherapy
1 Department of Internal Medicine, Division of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, TX
2 Department of Internal Medicine, Division of Hematology and Oncology, Indiana University School of Medicine, Melvin and Bren Simon Cancer Center
3 Department of Surgery, Cardiothoracic Division, Indiana University School of Medicine, Indianapolis, IN, USA
* Correspondence to: Dr S. M. Radaideh, Division of Hematology and Oncology, University of Texas Southwestern Medical Center, 2201 Inwood Road, Dallas, TX 75390, USA. Tel: +1-214-552-8455; Fax: +1-214-648-1955; E-mail: smrada{at}parknet.pmh.org
Background: To assess the outcome of surgical resection in patients with primary mediastinal nonseminomatous germ-cell tumors (PMNSGCT) with rising serum tumor markers (STM) following standard platinum-based chemotherapy.
Patients and methods: A total of 158 consecutive patients with PMNSGCT who received platinum-based chemotherapy followed by complete surgical extirpation of residual disease at Indiana University from 1982 to 2007 were retrospectively reviewed. Thirty-five of these 158 patients had rising STM at time of resection.
Results: Thirty-five patients (34 males and 1 female) comprise the basis of this report. Three patients had rising human chorionic gonadotropin, and the remaining 32 patients had rising alpha-fetoprotein at the time of thoracic surgery. Twenty-four of the 35 (69%) pathologically demonstrated viable germ-cell tumor, while 8 patients had teratoma and 3 patients had necrosis only at time of resection, despite the presence of rising STM. Twenty-seven patients normalized their tumor markers postoperatively. Twenty-one of 35 died, 5 were lost to follow-up, and 9 are alive. Of the nine patients alive, seven are continuously disease free with median follow-up of 64 months (range 25–220 months).
Conclusion: The presence of rising STM doesn't preclude successful therapy with surgical resection, especially if carried out by experienced thoracic surgical oncologists.
outcome, primary mediastinal nonseminomatous germ-cell tumors, resection, surgery, tumor markers
Received for publication July 4, 2009. Revision received September 27, 2009. Accepted for publication October 6, 2009.