Outcome following resection for patients with primary mediastinal nonseminomatous germ-cell tumors and rising serum tumor markers post-chemotherapy.
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.


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).


CONCLUSIONS
The presence of rising STM doesn't preclude successful therapy with surgical resection, especially if carried out by experienced thoracic surgical oncologists.
Radaideh
S M
SM
Department of Internal Medicine, Division of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: smrada@parknet.pmh.org.
Cook
V C
VC
Department of Internal Medicine, Division of Hematology and Oncology, Indiana University School of Medicine, Melvin and Bren Simon Cancer Center.
Kesler
K A
KA
Department of Surgery, Cardiothoracic Division, Indiana University School of Medicine, Indianapolis, IN, USA.
Einhorn
L H
LH
Department of Internal Medicine, Division of Hematology and Oncology, Indiana University School of Medicine, Melvin and Bren Simon Cancer Center.
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D054316:Biomarkers, Pharmacological / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D015854:Up-Regulation / Q000187:drug effects; D055815:Young Adult
D054316:Biomarkers, Pharmacological; D014408:Biomarkers, Tumor