How would you treat a residual mediastinal mass in patients with a mediastinal germ cell tumor with an incomplete response to primary chemotherapy with BEPx4?
How would you treat a residual mediastinal mass in patients with a mediastinal germ cell tumor with an incomplete response to primary chemotherapy with BEP x 4?
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Several comments:
1. VIP is preferred over BEP for PMNSGCT if there will be consideration for extensive mediastinal resection (JCO 34:4445,2016)
2. Patient should be evaluated at a center with experienced and skilled thoracic surgical oncology to determine if patient is truly inoperable.
3. Need more information about tumor markers. Are they declining and might normalize in a few weeks or are they rising? There is still a cure rate with disease localized to the mediastinum even in the face of a rising AFP or hCG (Ann Onc 21:804, 2010)
4. if markers rising and patient truly not a candidate for resection, the ONLY chance for cure would be with high dose chemo followed by peripheral blood stem cell transplant.
5. No role for radiotherapy
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