title: Outcomes of combined modality therapy for patients with stage III or IV mediastinal malignant germ cell tumors.
abstract: OBJECTIVE
  The treatment of primary mediastinal germ cell tumors with cisplatin-based chemotherapy followed by surgery is an established practice; however, the prognosis has remained poor. This study reviews the survival outcomes of patients with primary mediastinal germ cell tumors to evaluate the efficacy of our treatment.
  
  
  METHODS
  We retrospectively reviewed 11 consecutive patients with primary mediastinal germ cell tumors.
  
  
  RESULTS
  We had treated four patients with seminomas and seven patients with non-seminomas. Ten patients had undergone cisplatin-based chemotherapy. All patients underwent complete resection. Two patients showed a failure of first-line chemotherapy and thus received salvage chemotherapies, including paclitaxel plus ifosfamide followed by high-dose carboplatin plus etoposide (TI-CE) with stem cell transplantation. One of them died of relapse 29 months later; while the other patient remained disease-free for 56 months postoperatively. The postoperative overall 3-year survival rates of the patients with non-seminomas and seminomas were 83 and 100%, respectively.
  
  
  CONCLUSIONS
  Complete resection after establishing normalized or decreased at a low-level serum tumor markers plateau plays a crucial role in the management of patients with primary mediastinal malignant germ cell tumors.
authors.affiliation: Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, kobecb77@yahoo.co.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kuwano
authors.forename: Takehiro
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Tomonori
authors.initials: T
authors.lastname: Murayama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sano
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nagayama
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Murakawa
authors.forename: Jun
authors.initials: J
authors.lastname: Nakajima
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D008479:Mediastinal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017239:Paclitaxel / Q000008:administration & dosage; D012189:Retrospective Studies; D016879:Salvage Therapy; D033581:Stem Cell Transplantation; D015996:Survival Rate; D019616:Thoracic Surgical Procedures; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005047:Etoposide; D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin; D007069:Ifosfamide
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