title: Surgical outcomes in patients with primary mediastinal non-seminomatous germ cell tumours and elevated post-chemotherapy serum tumour markers.
abstract: OBJECTIVE
  Platinum-based chemotherapy followed by surgical resection of residual masses has become the standard treatment of patients with primary mediastinal non-seminomatous germ cell tumours (NSGCTs). Persistent serum tumour marker (STM) elevation after chemotherapy usually indicates a poor prognosis. We retrospectively assessed surgical outcomes in patients with high STM levels after chemotherapy for primary mediastinal NSGCT.
  
  
  METHODS
  Between 1983 and 2010, residual tumour excision was performed in 21 patients, 20 men and one woman with a median age of 30 years (range: 19-49 years), with primary mediastinal NSGCTs and high STM levels after platinum-based chemotherapy, followed by second-line chemotherapy in 11 patients.
  
  
  RESULTS
  Alpha-fetoprotein was elevated in all 21 patients and β-human chorionic gonadotropin in three patients. Permanent histology demonstrated viable germ cell tumour (n=13), teratoma (n=3) or necrosis (n=5). After surgery, the STM levels returned to normal in 11 patients. Eight patients are alive with a median follow-up of 98 months. The 5-year survival rate was 36% and was not significantly affected by the use of preoperative second-line chemotherapy. At univariate analysis, only postoperative STM elevation and residual viable tumour, indicating incomplete resection, were significantly associated with lower survival (P=0.018 and P=0.04, respectively).
  
  
  CONCLUSIONS
  In patients with primary mediastinal NSGCTs and elevated post-chemotherapy STMs, surgery is warranted when complete resection is deemed feasible. In specialized oncology centres, this aggressive approach can provide a cure in some patients.
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation,  Hôpital Marie-Lannelongue, Le Plessis Robinson,  France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: De Latour
authors.forename: Elie
authors.initials: E
authors.lastname: Fadel
authors.forename: Olaf
authors.initials: O
authors.lastname: Mercier
authors.forename: Sacha
authors.initials: S
authors.lastname: Mussot
authors.forename: Dominique
authors.initials: D
authors.lastname: Fabre
authors.forename: Karim
authors.initials: K
authors.lastname: Fizazi
authors.forename: Philippe
authors.initials: P
authors.lastname: Dartevelle
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008479:Mediastinal Neoplasms / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D056346:Sternotomy; D013736:Testicular Neoplasms; D013908:Thoracotomy; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: C097353:AFP protein, human; D000970:Antineoplastic Agents; D018997:Chorionic Gonadotropin, beta Subunit, Human; D000509:alpha-Fetoproteins