Intensive chemotherapy and radical resections for primary nonseminomatous mediastinal germ cell tumors Garrett L Walsh, MD, Grant D Taylor, BS, Jonathan.

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Intensive chemotherapy and radical resections for primary nonseminomatous mediastinal germ cell tumors Garrett L Walsh, MD, Grant D Taylor, BS, Jonathan C Nesbitt, MD, Robert J Amato, MD The Annals of Thoracic Surgery Volume 69, Issue 2, Pages 337-343 (February 2000) DOI: 10.1016/S0003-4975(99)01472-1

Fig 1 Computed tomographic scans demonstrating a large tumor of mixed histologies (embryonal carcinoma and choriocarcinoma) in a 31-year-old man who presented with superior vena cava syndrome and a pleural effusion. (Top) Before treatment, and (bottom) after treatment with 15 courses (4 cycles) of chemotherapy (BOP/CISCA/POMB/ACE). The Annals of Thoracic Surgery 2000 69, 337-343DOI: (10.1016/S0003-4975(99)01472-1)

Fig 2 Computed tomography of a nonseminomatous germ cell tumor (embryonal histology) in a 38-year-old man who presented with voice hoarseness and bulky neck nodes. (Top) Before treatment, and (bottom) after 8 courses (2 cycles) of chemotherapy. He required sacrifice of the left recurrent nerve and extensive mediastinal lymphadenectomy with neck dissection. Final pathology demonstrated 100% tumor necrosis. There is no evidence of disease at follow-up 3 years. The Annals of Thoracic Surgery 2000 69, 337-343DOI: (10.1016/S0003-4975(99)01472-1)

Fig 3 Resected specimen of a 33-year-old man with a 15-day history of chest and shoulder pain that failed conventional BEP chemotherapy (4 courses) at another hospital and normalized his markers after one cycle of BOP/CISCA/POMB/ACE. The final pathology demonstrated greater than 99% necrosis with one microscopic focus of angiosarcoma. He had postoperative courses of adriamycin and ifosfamide and there is no evidence of disease 3 years later. The Annals of Thoracic Surgery 2000 69, 337-343DOI: (10.1016/S0003-4975(99)01472-1)

Fig 4 Overall survival of 20 patients with nonseminomatous germ cell tumors of mediastinal origin, treated over the past 5 years with a standardized dose-intensified chemotherapy regimen. Two-year survival is 58%. The Annals of Thoracic Surgery 2000 69, 337-343DOI: (10.1016/S0003-4975(99)01472-1)

Fig 5 Survival curves of patients referred for initial treatment and salvage therapy to our hospital. The Annals of Thoracic Surgery 2000 69, 337-343DOI: (10.1016/S0003-4975(99)01472-1)