Would you recommend consolidative RT for a mediastinal germ cell tumor with partial response after chemotherapy?

There is no evidence or logic in postchemotherapy radiotherapy for patients with residual mass with nonseminomatous germ cell tumor. Instead such patients should be referred to a thoracic surgeon with experience and skill in resecting residual masses.

For mediastinal seminoma, there will almost always be a residual mass postchemotherapy. Almost all such masses represent necrosis as the cure rate with just BEP X 3 alone is > 90% . Such patients should be observed and if there is progressive seminoma, the cure rate with salvage chemotherapy is remarkably high (79-90%) .

What Dr Einhorn said! If this is a mediastinal nonseminoma without significant extra mediastinal residual and has had a favorable serologic response, would strongly consider referral to expert center with a very experienced thoracic team willing to do the necessary and often complicated surgery.

Mediastinal primary or not, management of residual masses in seminoma almost never should include radiation of residual masses.