title: Long-term outcomes of pediatric and adolescent mediastinal germ cell tumors: a single pediatric oncology institutional experience.
abstract: OBJECTIVE
  To evaluate the epidemiologic, demographic, and clinical characteristics, as well as prognostic factors and long-term outcomes of mediastinal germ cell tumors (MGCT) in children.
  
  
  METHODS
  A retrospective study of pediatric patients diagnosed with a primary MGCT between January 1963 and August of 2014 was performed.
  
  
  RESULTS
  Twenty-five patients were identified. Six children with teratomas were treated with resection alone (median age 7.8 years, range newborn to 15 years) and were cured without recurrence or progression. Nineteen children were treated for a malignant MGCT (median age 11.7 years, range 7 months-18 years); 5 year overall survival (OS) was 0.39 ± 0.12. For malignant non-seminomatous mediastinal germ cell tumors, platinum-based chemotherapy regimen (OS 0.56 vs 0.14, p = 0.03), complete surgical resection with negative margins (OS 0.73 vs 0.11, p = 0.03); and localized disease (OS 0.76 vs 0.0, p = 0.004) demonstrated a survival advantage.
  
  
  CONCLUSIONS
  Initial surgical resection is appropriate for teratomas. Localized disease, complete resection, and platinum-based chemotherapy are associated with improved survival in malignant non-seminomatous mediastinal germ cell tumors. Neoadjuvant, platinum-based three drug regimens followed by delayed surgical resection is the appropriate treatment modality for malignant mediastinal germ cell tumors.
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: D F
authors.initials: DF
authors.lastname: Grabski
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: A S
authors.initials: AS
authors.lastname: Pappo
authors.affiliation: Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Krasin
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Davidoff
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: B N
authors.initials: BN
authors.lastname: Rao
authors.affiliation: Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA. Israel.Fernandez-Pineda@stjude.org.
authors.forename: I
authors.initials: I
authors.lastname: Fernandez-Pineda
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D020360:Neoadjuvant Therapy / Q000379:methods*; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Mediastinal germ cell tumors; Non-seminomatous germ cell tumors; Pediatric germ cell tumor; Pediatric mediastinal tumors