title: Influence of suboptimal treatment in patients with mediastinal primary nonseminomatous germ cell tumors.
abstract: OBJECTIVE
  The aim of this study was to analyze the prognostic impact of suboptimal treatment in patients with mediastinal primary nonseminomatous germ cell tumor (MNSGCT).
  
  
  METHODS
  We retrospectively reviewed the clinical data of 23 consecutive MNSGCT patients who were referred to the National Cancer Center Hospital between 1999 and 2007. Optimal treatment was defined as a primary chemotherapy regimen comprising a standard dosage of bleomycin + etoposide + cisplatin or etoposide + ifosfamide + cisplatin with sufficient dose intensity according to the guidelines of the European Germ Cell Cancer Consensus Group.
  
  
  RESULTS
  Ten and 13 patients received optimal and suboptimal treatment, respectively. The progression-free survival was statistically different between the patients who received optimal and suboptimal treatment (p = 0.01), and the hazard ratio of the optimal treatment group relative to the suboptimal treatment group was 0.19 (95% CI, 0.04-0.89). Although the overall survival was not statistically different between the 2 patient groups (p = 0.12), the hazard ratio in this regard was 0.36 (95% CI, 0.10-1.38).
  
  
  CONCLUSIONS
  Patients who receive suboptimal treatment have poor clinical outcomes. Providing treatment after considering evidence-based guidelines may be important for improving the clinical outcomes of MNSGCT patients.
authors.affiliation: Breast and Medical Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. kyonemor@ncc.go.jp
authors.forename: Kan
authors.initials: K
authors.lastname: Yonemori
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kouno
authors.forename: Masashi
authors.initials: M
authors.lastname: Ando
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hirakawa
authors.forename: Harukaze
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Makiko
authors.initials: M
authors.lastname: Ono
authors.forename: Taizo
authors.initials: T
authors.lastname: Hirata
authors.forename: Chikako
authors.initials: C
authors.lastname: Shimizu
authors.forename: Kenji
authors.initials: K
authors.lastname: Tamura
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Katsumata
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujiwara
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006801:Humans; D008479:Mediastinal Neoplasms / Q000188:drug therapy*; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents