Apr 4, 1995 - NSGCT. 12 yolk sac carcinoma. Lung pericardium. Thoracoscopic resection of lung met + mediastinal mass biopsy. EP = Etoposide + Cisplatin, ...
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
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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
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A. T.C. CHAN ET
Acta Oncologica 35 (1996)
AL
Table 1 Patient chracteris
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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
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1 15800
> 200
biopsy residual changes PWx5
7650