Response to chemotherapy, measured by normalisation or decreases in preoperative tumour markers, predicts improved survival for patients with primary mediastinal nonseminomatous germ cell tumours (PMNGCTs), undergoing surgical resection of residual tumour mass, reports the Journal of Thoracic Oncology.

The main stay of treatment for patients with PMNGCTs is aggressive, multidrug chemotherapy, with surgery considered an adjuvant treatment for resection of residual tumours in patients who have respond to chemotherapy. Outcomes of PMNGCT, which is primarily a disease of children and young men, are generally poor with five year survival rates reported of between 30 and 48%.

The purpose of the current study by Inderpal Sarkaria and colleagues, from Memorial Sloan-Kettering Cancer Center (New York), was to analyze the surgical experience of a single institution with PMNGCTs, with a view to identifying predictors of outcome and survival. Altogether the charts of 57 patients resected for PMNGCTs between July 1980 and April 2008, were reviewed. Those patients who survived were followed up for a median of 5.3 years.

Results showed that factors correlating with better survival on univariate analyses were necrosis or teratoma versus residual cancer on final pathology (p=0.001), RO resection (p=0.03), normalised or decreased post c chemotherapy /preoperative tumour markers (p<0.001), normalised postoperative tumour makers (p=0.004), stage I/II disease (p=0.03) and surgery after 2000 versus between 1980 and 1999 (p=0.01).

"Complete radical resection of residual tumour mass after platinum-based chemotherapy for PMNGCT can be accomplished in most of appropriately selected patients with normalised or decreased tumour markers and may offer meaningful long term survival benefits," write the authors, adding that nevertheless given the poor alternative options surgery should also be offered to patients with increasing post chemotherapy markers if it is believed that complete resection can be achieved. Unfortunately, they say, hope for a cure remains bleak in this subset of patients , emphasizing the need for ongoing investigations of other salvage modalities for primary treatment failure.

Reference:

I S Sarkaria, M S Bains, S Sood, et al. Resection of Primary Mediastinal Non-Seminomatous Germ Cell Tumours: a 28 year experience at Memorial Sloan-Kettering Cancer Center. J Thorac Oncol; 2011: 6: 1236-1241.