Multimodality treatment of germ cell tumors of the mediastinum.

Germ cell tumors originating in the anterior mediastinal compartment represent a rare but biologically interesting group of neoplasms. Knowledge of the specific biologic behaviors and therapeutic strategies for the three histologic types is important. PMNSGCT represent the most challenging group of malignant germ cell tumors and survival outcome is dependant on both successful chemotherapy and surgery to remove residual disease when feasible. The authors currently believe nonbleomycin-containing regimens will reduce operative risks in this regard. New chemotherapy strategies that reduce the incidence of persistent nonseminatous germ cell or non-germ cell cancer need continued investigation. Although overall survival is inferior to nonseminomatous germ cell tumors of testicular origin, favorable subsets with pathologic evidence of either necrosis or teratoma have been identified. An aggressive surgical approach after cisplatin-based chemotherapy can result in long-term survival, even in patients with persistent nonseminomatous germ cell or non-germ cell cancer, and is warranted in these otherwise young and healthy patients.