title: Evaluation of neoadjuvant therapy in patients with nongerminomatous malignant germ cell tumors.
abstract: OBJECTIVE
  The authors evaluated the effectiveness of a neoadjuvant therapy (NAT) consisting of combined chemo and radiotherapy followed by complete resection of the residual tumor in patients with nongerminomatous malignant germ cell tumors (NGMGCTs).
  
  
  METHODS
  The authors treated 14 consecutive patients in whom NGMGCTs were diagnosed based on elevated levels of the tumor markers α-fetoprotein, human chorionic gonadotropin, and the β-subunit of human chorionic gonadotropin (β-HCG). Chemotherapy and radiotherapy were performed, and after the serum tumor markers level was in the normal or near-normal range, the residual tumors were completely resected.
  
  
  RESULTS
  Residual tumors were confirmed in 11 of the 14 patients after NAT, and total removal was successful in 10 of the 11 patients. In the other patient the residual tumor could not be completely excised because it was attached to a deep vein. The follow-up duration ranged from 1.2 to 22.2 years. The 5-year event-free and total survival rates were 86% and 93%, respectively. Although 3 patients died, 2 of tumor recurrence and 1 of a radiation-induced secondary tumor (glioblastoma), the other 11 are alive and without evidence of tumor recurrence.
  
  
  CONCLUSIONS
  The authors consider their NAT protocol for NGMGCT to be highly effective in relation to survival for the patients with NGMGCT, but there are several quality of life issues that need to be resolved.
authors: Department of Neurosurgery, Faculty of Medical and Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan. hnakamur@fc.kuh.kumamoto-u.ac.jp
authors: Hideo
authors: H
authors: Nakamura
authors: Keishi
authors: K
authors: Makino
authors: Masato
authors: M
authors: Kochi
authors: Yukitaka
authors: Y
authors: Ushio
authors: Jun-ichi
authors: J
authors: Kuratsu
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001855:Bone Marrow Diseases / Q000139:chemically induced / Q000453:epidemiology; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004314:Down Syndrome / Q000150:complications; D017809:Fatal Outcome; D005260:Female; D005909:Glioblastoma / Q000209:etiology; D020249:Hormone Replacement Therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D009364:Neoplasm Recurrence, Local; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000473:pathology; D019635:Neurosurgical Procedures; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult