Induction chemotherapy, surgical resection, and high-dose chemotherapy for mediastinal nonseminomatous germ-cell tumor

Abstract

Clinical Summary Three young men with large mediastinal NSGCTs met the requirements to enter the study (Figure 1 and Table 1). All patients were given pathologic diagnoses of NSGCT on the basis of needle biopsy and showed increased alpha-fetoprotein (AFP) levels. Testicular ultrasonography was performed to rule out testicular primaries. Planned treatment began with induction chemotherapy consisting of cisplatin, etoposide, and bleomycin. Cisplatin was administered at a dose of 20 mg · m 2 on days 1 through 5, etoposide was administered at a dose of 100 mg · m 2 on days 1 through 5, and bleomycin was administered at a dose of 20 mg · m 2 on days 1, 8, and 15. The bleomycin, etoposide, and cisplatin (BEP) induction chemotherapy was delivered for 4 cycles at 2-week intervals. During hematologic recovery after the third or fourth cycle of the induction chemotherapy, peripheral blood stem cells were collected by means of apheresis with a continuous blood cell separator. Patients underwent a median sternotomy with or without anterolateral thoracotomy within 6 weeks of completing induction chemotherapy. Total thymectomy with combined resection of the invaded surrounding tissue was carried out. After full recovery from the operation, patients received HDCT consisting of carboplatin, ifosfamide, and etoposide. Carboplatin was administered at a dose of 400 mg · m 2 on days 7, 5, and 3. Ifosfamide was administered at a dose of 3 g · m 2 on days 7 through 3. Etoposide was administered at a dose of 500 mg · m 2 on days 7, 5, and 3. PBSCT containing peripheral blood stem cells (3.6-11.2 10 CD34 cells per kilogram) was performed 72 hours after completing HDCT (day 0) and just after administration of methylprednisolone (250 mg). Granulocyte colony-stimulating factor was administered subcutaneously at a dose of 250 g beginning on day 1 and continued until an absolute neutrophil count of 1000 L was achieved.