eMedicine Specialties > Thoracic Surgery > Tumors

Mediastinal Seminoma: Follow-up

Author: Shabir Bhimji, MD, PhD, Locum Cardiothoracic and Vascular Surgeon, Saudi Arabia and Middle East Hospitals
Contributor Information and Disclosures

Updated: Oct 31, 2008

Outcome and Prognosis

Surgical results for mediastinal seminomas range from poor to borderline. All series in which a mediastinal mass has been completely resected have shown 5-year survival rates of less than 50%, with a greater than 40% chance of recurrence. However, most patients who present with seminomas have a large anterior mediastinal mass, and surgery is rarely the first choice of treatment.

In the last decade, the general trend has been to refer all patients with seminomas, regardless of size, for radiation therapy and chemotherapy. In current practice, seminomas are curable with aggressive treatment.4 The treatment of pure seminomas today is nonsurgical; only the small, resectable tumors in asymptomatic patients should be completely excised and managed with postoperative radiation, with doses of 40-50 Gy.

If distant metastases are detected at the time of diagnosis, the patient should be treated with intensive cisplatin-based combination chemotherapy. Even though these tumors are very sensitive to radiation, remissions are observed in only 50-70% of patients; therefore, combination chemotherapy is recommended for bulky disease and radiation is recommended for localized disease.

For bulky tumors, induction chemotherapy is administered and any residual disease revealed on a CT scan is then resected to determine if a viable tumor remains. A finding positive for a tumor may dictate further therapy. If no lesion is observed on the CT scan, no further therapy is warranted and the patient can be monitored with serial CT scans every 6-12 months. Current treatment regimens provide remission in more than 80% of individuals, and the 5-year survival rate is reported to be approximately 60-80%.

Future and Controversies

Seminomas generally affect young males in their second or third decade of life. For localized seminomas, the current treatment is radiation. Surgery is reserved for patients with residual masses after successful treatment with radiation, chemotherapy, or both. Because most patients are young, an aggressive approach with newer, multimodality treatments should be the intent in all patients.

 


More on Mediastinal Seminoma

Overview: Mediastinal Seminoma
Workup: Mediastinal Seminoma
Treatment: Mediastinal Seminoma
Follow-up: Mediastinal Seminoma
References
[ CLOSE WINDOW ]

References

  1. Weidner N. Germ-cell tumors of the mediastinum. Semin Diagn Pathol. Feb 1999;16(1):42-50. [Medline].

  2. Flechon A, Biron P, Philip I, et al. [High dose chemotherapy with autologous stem cell support in the treatment of germ cell tumors: experience of the centre Leon-Berard between 1982 and 1996]. Bull Cancer. Apr 1999;86(4):391-9. [Medline].

  3. Gholam D, Fizazi K, Terrier-Lacombe MJ, et al. Advanced seminoma--treatment results and prognostic factors for survival after first-line, cisplatin-based chemotherapy and for patients with recurrent disease: a single-institution experience in 145 patients. Cancer. Aug 15 2003;98(4):745-52. [Medline].

  4. Thomas GM. Over 20 Years of Progress in Radiation Oncology: Seminoma. Semin Radiat Oncol. Apr 1997;7(2):135-45. [Medline].

  5. Algaba Arrea F. [Morphologic keys for the interpretation of the biology of testicular germ tumors]. Arch Esp Urol. Jul-Aug 2000;53(6):407-21. [Medline].

  6. Amato RJ, Millikan R, Daliani D, et al. Cyclophosphamide and carboplatin and selective consolidation in advanced seminoma. Clin Cancer Res. Jan 2000;6(1):72-7. [Medline].

  7. Fang FM, Ko SF, Hwang CH, Wang CJ. Healing of superior vena cava defect in mediastinal seminoma with invasion. Ann Thorac Surg. Aug 2000;70(2):667-9. [Medline].

  8. Ganjoo KN, Chan RJ, Sharma M, Einhorn LH. Positron emission tomography scans in the evaluation of postchemotherapy residual masses in patients with seminoma. J Clin Oncol. Nov 1999;17(11):3457-60. [Medline].

  9. Hainsworth JD. Diagnosis, staging, and clinical characteristics of the patient with mediastinal germ cell carcinoma. Chest Surg Clin N Am. Nov 2002;12(4):665-72. [Medline].

  10. Horvath L, Bayfield M, Clifford A, et al. Unusual presentations of germ cell tumors. Case 1. Recurrent laryngeal nerve palsy in mediastinal seminoma. J Clin Oncol. Feb 1 2001;19(3):909-11. [Medline].

  11. Komatsubara S, Itoi T, Watanabe M, et al. [Treatment of metastatic seminoma by chemotherapy, an experience]. Nippon Hinyokika Gakkai Zasshi. Oct-Nov 2000;91(10-11):666-72. [Medline].

  12. Lemarie E. [Malignant germinal tumours of the mediastinum: diagnosis and treatment]. Rev Pneumol Clin. Nov 2004;60(5 Pt 2):3S79-85. [Medline].

  13. Moran CA. Germ cell tumors of the mediastinum. Pathol Res Pract. 1999;195(8):583-7. [Medline].

  14. Okada M, Sugimoto T, Yamamoto H. [Surgical strategy for invasive pulmonary and mediastinal tumors requiring superior vena cava reconstruction]. Kyobu Geka. Jan 1999;52(1):14-8. [Medline].

  15. Oyoshi T, Nakayama M, Hirano H, et al. Intracranial dural metastasis of mediastinal seminoma--case report. Neurol Med Chir (Tokyo). Aug 2000;40(8):423-6. [Medline].

  16. Pectasides D, Aravantinos G, Visvikis A, et al. Platinum-based chemotherapy of primary extragonadal germ cell tumours: the Hellenic Cooperative Oncology Group experience. Oncology. Jul 1999;57(1):1-9. [Medline].

  17. Rick O, Beyer J, Kingreen D, et al. High-dose chemotherapy in germ cell tumours: a large single centre experience. Eur J Cancer. Nov 1998;34(12):1883-8. [Medline].

  18. Silverman JF, Olson PR, Dabbs DJ, Landreneau R. Fine-needle aspiration cytology of a mediastinal seminoma associated with multilocular thymic cyst. Diagn Cytopathol. Apr 1999;20(4):224-8. [Medline].

  19. Takeda S, Miyoshi S, Omori K, et al. Surgical rescue for life-threatening hypoxemia caused by a mediastinal tumor. Ann Thorac Surg. Dec 1999;68(6):2324-6. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

mediastinal seminoma, germ cell, germ cell tumor, germ-cell tumor, germ cell mass, germ-cell mass, malignant germ cells of the mediastinum, seminoma, radiation, mediastinum, gonads, mediastinal mass, cisplatin-based chemotherapy, respiratory compromise, intrathoracic mass, anterior mediastinal mass, extragonadal malignancy, totipotential cells, spermatogenesis, median sternotomy, median sternotomy exploration, teratoma, radiation, chemotherapy, cisplatin, vinca alkaloids, etoposide, ifosfamide, bleomycin, combination chemotherapy, induction chemotherapy, mediastinum cancer, mediastinal cancer, malignant seminoma, benign seminoma

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Shabir Bhimji, MD, PhD, Locum Cardiothoracic and Vascular Surgeon, Saudi Arabia and Middle East Hospitals
Shabir Bhimji, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Chest Physicians, American Lung Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey C Milliken, MD, Chief, Division of Cardiothoracic Surgery, University of California at Irvine Medical Center; Clinical Professor, Department of Surgery, University of California at Irvine School of Medicine
Jeffrey C Milliken, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Thoracic Surgery, American College of Cardiology, American College of Chest Physicians, American College of Surgeons, American Heart Association, American Society for Artificial Internal Organs, California Medical Association, International Society for Heart and Lung Transplantation, Phi Beta Kappa, Society of Thoracic Surgeons, Southwest Oncology Group, and Western Surgical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Shreekanth V Karwande, MBBS, Chair, Professor, Department of Surgery, Division of Cardiothoracic Surgery, University of Utah School of Medicine and Medical Center
Shreekanth V Karwande, MBBS is a member of the following medical societies: American Association for Thoracic Surgery, American College of Chest Physicians, American College of Surgeons, American Heart Association, Society of Critical Care Medicine, Society of Thoracic Surgeons, and Western Thoracic Surgical Association
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Mary C Mancini, MD, PhD, Professor, Department of Surgery, Louisiana State University Health Sciences Center
Mary C Mancini, MD, PhD is a member of the following medical societies: American Heart Association, American Medical Association, American Thoracic Society, Association for Academic Surgery, Association for Surgical Education, International College of Surgeons, International Society for Heart and Lung Transplantation, New York Academy of Sciences, Phi Beta Kappa, and Southern Thoracic Surgical Association
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.