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  MTE 11 - Mediastinal Tumors Including Thymic Tumors, Lymphoma, Germ-Cell Tumors: Biology, Diagnosis and Treatment (Ticketed Session) (ID 63)

  • Event: WCLC 2015
  • Type: Meet the Expert (Ticketed Session)
  • Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/07/2015, 07:00 - 08:00, 201+203

  • 13412

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    MTE11.01 - Mediastinal Tumors Including Thymic Tumors, Lymphoma, Germ-Cell Tumors: Biology, Diagnosis and Treatment (ID 1994)

    07:00 - 07:20  |  Author(s): L. Einhorn
    • Abstract
    • Presentation
    • Slides

    Abstract:
    Mediastinal germ cell tumors represent 2% of all germ cell tumors. The anterior mediastinum is the site of origin. There is never a clinical situation where a patient has a primary tumor in the testis with spread to the anterior mediastinum, as typical nodal spread goes to the ipsilateral retroperitoneal lymph nodes and subsequently to the posterior mediastinal. The most common mediastinal germ cell tumor is mature teratoma. These patients will have a normal hCG and AFP and routinely be cured with surgical resection alone. Mediastinal seminomas are all good-risk disease unless there is spread to liver, bone, or brain. Patients with mediastinal seminomas might have a slight elevation of hCG, but would never have an elevation of serum alphafetoprotein. In the past, they were treated with radiation therapy, but now they are treated with standard chemotherapy, usually BEP x 3 unless the patient is over age 50. Despite the size of the tumor, the expected cure rate is 90-100%. Primary mediastinal non-seminomatous germ cell tumor reflects a much worse prognosis and regardless of the size of the tumor or amplitude of tumor marker, they are all categorized as advanced disease. These tumors represent a real challenge for the multi-disciplinary team consisting of medical oncology and thoracic surgery. The cure rate is only 40-50% and if cure is not possible with first-line therapy, subsequent cures with any form of non-surgical salvage chemotherapy, including high dose chemotherapy, is very low. We prefer etoposide (VP-16) + ifosfamide + cisplatin (VIP) for 4 cycles in preference to BEP x 4. A prior phase III study in advanced germ cell tumors of any category revealed similarity in cure rates with these 2 regimens. Because these patients will usually require extensive thoracic resections, we prefer to avoid the 12 weeks of bleomycin. The ability to cure these complicated patients is dependent upon the diagnostic skill of pathologists, the clinical acumen of medical oncologists, but especially the skill and experience of thoracic surgical oncologists. It is strongly advised that such patients be seen at tertiary centers for optimal management, especially surgery.
    
    

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