Author of

• 12755

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  P3.16 - Poster Session 3 - Other Thoracic Malignancies (ID 188)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Thymoma & Other Thoracic Malignancies
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12758

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    P3.16-003 - Overall Survival and Surgical Outcomes for Mediastinal germ-cell tumors: The National Cancer Institute of Mexico experience. (ID 3361)

    09:30 - 09:30  |  Author(s): M.A. Alvarez-Avitia
    • Abstract

    Background
    Extragonadal germ-cell are rare, most of them arising in the anterior mediastinum and comprise less than 5% of all germ-cell malignancies, Although they also occur in women, the men are the most affected. This tumors are considered with a worse prognosis than their primary gonadal counterparts. Standar treatment includes chemotherapy with bleomycin, etoposide and cisplatin, sometimes followed by surgery. Five-year overall survival is about 45%

    Methods
    Retrospective, single institution review from January 2005 to december 2012. We included patients with mediastinal germ-cell tumors treated with chemotherapy plus surgery. We reviewed patient characteristics to identify factors associated with overall survival.

    Results
    We included 28 patients in the final analysis, there were 25 males (89.3%) and 3 females (10.7%), mean age 26.71 years (range 15 -39 years). Mediastinal tumor and elevated serum tumor markers were present in 22 patients; in 6 patients a pre-treatment biopsy was needed because serum tumor markers were negative. Non-seminomaotus germ-cell tumor was diagnosed in 22 patients, seminoma in 2 patients and mature teratoma in 4 patients. Except for the teratoma patients, all received preoperative chemotherapy, BEP regimen was used in 53.6% of patients. A second line of chemotherapy was used in 8 patients (28.6%) and only 1 patient received a third line of chemotherapy. Serum tumor markers prior to surgery were negative in 19 patients, meanwhile 9 patients underwent surgery with positive serum tumor markers. Surgical approach was made by median esternotomy in 15 patients, and posterior thoracotomy in 11 patients. Extensive resections (including lung resection and/or pericardial resection and/or bone resection) were performed in 16 patients. Perioperative mortality was 3.6% (one pneumonectomy patient). Median size tumor was 13.3 cm (range 4-25 cm) Complete resection was achieved in 23 patients (82.1%). Pathology in surgical specimens were viable germ-cell tumor in 12 patients (42.9%), mature teratoma in 6 patients (23.4%), inmature teratoma in 4 patients (14.3%) , necrosis in 4 patients (14.3%) and seminoma in 2 patients (7.1%). Only 7 patients (25%) received an additional line of postoperative chemotherapy. Median overall survival was 18.32 months (range 1-102 months). Seminoma and teratoma were associated with longer survival, meanwhile in non-seminoatous tumors preoperative negative serum tumor markers showed a better prognosis.

    Conclusion
    Surgical outcomes have improved over time with a positive impact in overall survival. Although the prognosis still worse for this subgroup of patients with extragonadal germ-cell tumors, our results indicates that a proper selection with agressive surgery entitles a better prognosis with low mortality. Factors associated with better survival were histology, serum tumor markers status prior to surgery and pathologic report of the surgical specimen.