Primary mediastinal seminoma. Efficacy of chemo-radiotherapy alone.

A treatment policy must be established for primary mediastinal seminoma. We have treated five patients with this entity during 18 years. All our patients presented with a bulky mass as is usual for this disease. Our first patient was treated surgically and then with radiation, but developed recurrences and died 11 years after the initial diagnosis. Three subsequent patients, one with multiple lymph node metastases, were treated with radiation followed by cisplatin. Our most recent patient received two courses of adriamycin-reinforced PVB, and then radiation for consolidation, followed by another course of chemotherapy. For these five patients, the 5- and 10-year survival rates were both 100%. A review of the literature emphasized the fact that either radiation or surgery has recently been replaced by chemotherapy as the front-line treatment of this rare tumor in light of a better response to the latter form of treatment. We fully agree with this policy. Based on the favorable long-term results of our patients we conclude that chemo-radiotherapy can cure primary mediastinal seminoma, even in its extended form, without surgery. An initial three courses of cisplatin-based chemotherapy like adriamycin-reinforced PVB or BEP should be followed by radiation of up to 4,000 cGy for consolidation. Surgery may play a limited role for tumors that are small at presentation, or for any possible viable residue seen on roentgenograms following chemo-radiotherapy.