Primary Mediastinal Malignant Germ Cell Tumour ...

Acta Oncologica Vol. 35, No. 2, pp. 221-221, 1996

PRIMARY MEDIASTINAL MALIGNANT GERM CELL TUMOUR

Single institution experience in Chinese patients and correlation with specific alpha-fetoprotein bands

Acta Oncol Downloaded from informahealthcare.com by 114.215.173.53 on 05/20/14 For personal use only.

ANTHONYT.C. CHAN,STEPHENHo, ANTHONYP.C. YIM,ALEXANDER R. CHANG,PAULCHENG,JOYCEYUEN, THOMASW.T. LEUNGand PHILIP J. JOHNSON

Ten Chinese patients were reviewed, all with mediastinal germ cell tumours and treated in our centre during the past 8 years. Three patients with pure seminomas were given chemotherapy with or without radiotherapy. All achieved complete remission with no relapse. Seven patients with non-seminomatous germ cell tumours (NSGCT) were given chemotherapy, with or without surgery. Two patients with rapid decay of alpha-fetoprotein (AFP) levels (half-life d 7.2 days) during chemotherapy achieved complete remission with no relapse. Five patients with prolonged decay of AFP levels (half-life > 7.2 days) failed to achieve complete remission with initial chemotherapy and all but one patient died between 5 and 9 months later. One patient developed acute megakaryocytic leukaemia. Using isoelectric focusing, AFP bands specific to NSGCT were quantified, and comparison was made with the total AFP in five cases. In each case the change in NSGCT-specific AFP concentration in response to therapy closely paralleled that of total AFP. Estimation of NSGCT-specific AFP offers no apparent advantage in monitoring disease response or progression.

Malignant germ cell tumours (GCT) of the mediastinum account for about 15% of adult mediastinal tumours (1). Mediastinal seminomas have been reported to have a distinctly better prognosis than non-seminomatous GCT (NSGCT) (2-10). Radiotherapy (RT) has been the mainstay of treatment for mediastinal seminomas resulting in 60-80% long-term survival ( 1 1). However, these tumours are often very bulky and involve adjacent intrathoracic structures making radiotherapy technically difficult and

Received 4 April 1995. Accepted 3 September 1995. From the Department of Clinical Oncology and Sir YK Pao Cancer Centre (A.T.C. Chan, S. Ho, P. Cheng, J. Yuen, T.W.T. Leung, P.J. Johnson), Department of Surgery (A.P.C. Yim) and Department of Anatomical and Cellular Pathology (A.R. Chang), Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. Correspondence to: Prof. P.J. Johnson, Department of Clinical Oncology, Prince of Wales Hospital, Shatin, Hong Kong.

0 Scandinavian University Press 1996. ISSN 0284-186X

significantly increasing the morbidity arising from lung irradiation. Cisplatin-based chemotherapy in mediastinal seminomas has resulted in excellent survival figures and is increasingly being accepted as the mainstay treatment ( 12, 13). In NSGCT, the combination BEP (bleomycin, etopside and cisplatin) has emerged as the standard regimen (14, 15). Surgical clearance of residual tissue after chemotherapy is important and the presence of active disease after chemotherapy has been demonstrated to be a poor prognostic factor. In this study ten cases of mediastinal germ cell tumour treated in the Prince of Wales Hospital between 1987 and 1994 were reviewed. The treatment protocol has evolved over the years, both in the chemotherapy schedules and in the role of surgery and radiotherapy. The aim of this study is, first, to describe the characteristics, treatment and outcome of ten Chinese patients with mediastinal germ cell tumours. Secondly, we have correlated response to treatment with tumour marker changes, focusing on the newly described NSGCT-specific variant of AFP ( 16). 22 1

222

A. T.C. CHAN ET

Acta Oncologica 35 (1996)

AL

Table 1 Patient chracteris


Patient No.

Sex/

Diagnosis

age

Max. diameter of mediastinal mass cm

Metastases/ invasion

Diagnostic procedure

1

M/41

Seminoma

8

Lung, pericardium

Debulking surgery

2

M/22

Seminoma

10

Lung, pericardium

Debulking surgery

3

M/21

Seminoma

14

No

Biopsy

4

M/26

10

M/20

14

Paraaortic lymphadenopathy No

50% debulking

5

NSGCT yolk sac carcinoma NSGCT yolk sac carcinoma

95% debdking

6

M/21

NSGCT mixed histology

10

No

Biopsy

7

M/24

NSGCT mature teratoma

10

No

Biopsy

8

M/17

12

No

9

M/17

NSGCT mixed histology NSGCT embryonal carcinoma

15

Pericardium

90% debulking surgery Biopsy

10

M/19

NSGCT yolk sac carcinoma

12

Lung pericardium

Thoracoscopic resection of lung met + mediastinal mass biopsy

EP = Etoposide + Cisplatin, BEP = Bleomycin, Etoposide and Cisplatin, PEI = Cisplatin, Etoposide and Ifosamide, POMBACE = Cisplatin, Vincristine, Methotrexate, Bleomycin, Etoposide, Actinomycin D and Cyclophosphamide,

Acta Oncologica 35 (1996)

223

PRIMARY MEDIASTINAL GCT AND AFP BANDS

tics and treatment

Baseline AFP ng/ml

Subsequent therapy

Marker response

Status

PHCG IU/L

Overall survival (months)

< 10

505

PEI x 2

< 2 after 1 cycle

CR

42

< 2 after 1 cycle

CR

40

< 2 after 1 cycle

CR

8

AFP 3490 after 3 cycles then PD AFP 331 after 3 cycles then PD

DD

7

DD

5

AFP 4100

DD

9

Lowest AFP 592

DD

5

AFP 42000 AFP < 10 after 3 cycles

CR

16

AFP < 10 after 4 cycles

CR

12

AFP 71 after 4 cycles

CR

11

1 RT (40 Gy)

1 < 10

14.5

PEI x 2 PWXI

1 RT (9 GY)

1 < 10

3630

PWx5 BEP x 4


1 15800

> 200

biopsy residual changes PWx5

7650