Successful Treatment of Primary Mediastinal Seminoma With Radiotherapy Following Chemotherapy Under a Bloodless Treatment Policy Based on Patient's Religious Sentiments.

INTRODUCTION

Primary mediastinal seminoma is rare with a favorable prognosis when appropriately treated, and surgical resection after chemotherapy is the standard treatment. However, refusal of blood transfusion for religious reasons can limit curative surgical management.

CASE PRESENTATION: A 47-year-old Jehovah's Witness man was found to have a 10.8-cm anterior mediastinal tumor. Biopsy confirmed seminoma. As the patient refused transfusion, definitive chemotherapy followed by radiotherapy was selected. Three cycles of chemotherapy (etoposide, ifosfamide, and cisplatin) resulted in 44% tumor reduction and partial response. Intensity-modulated radiotherapy of the residual tumor (36 Gy in 20 fractions) achieved complete response, maintained for 11 months without recurrence or late toxicity.

CONCLUSION

Sequential chemotherapy followed by consolidative radiotherapy appeared to be a safe and effective option for primary mediastinal germ cell tumor in the short term when surgical resection was not feasible for religious reasons.