Evaluation of neoadjuvant therapy in patients with nongerminomatous malignant germ cell tumors

Clinical article

Hideo Nakamura M.D., Ph.D.1, Keishi Makino M.D., Ph.D.1, Masato Kochi M.D., Ph.D.2, Yukitaka Ushio M.D., Ph.D.3, and Jun-ichi Kuratsu M.D., Ph.D.1
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  • 1 Department of Neurosurgery, Faculty of Medical and Pharmaceutical Sciences, Kumamoto University, Kumamoto;
  • | 2 Department of Neurosurgery, Yawatahama City General Hospital, Ohira, Yawatahama, Ehime; and
  • | 3 Department of Neurosurgery, Otemae Hospital, Otemae, Osaka, Japan
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Object

The authors evaluated the effectiveness of a neoadjuvant therapy (NAT) consisting of combined chemoand radiotherapy followed by complete resection of the residual tumor in patients with nongerminomatous malignant germ cell tumors (NGMGCTs).

Methods

The authors treated 14 consecutive patients in whom NGMGCTs were diagnosed based on elevated levels of the tumor markers α-fetoprotein, human chorionic gonadotropin, and the β-subunit of human chorionic gonadotropin (β-HCG). Chemotherapy and radiotherapy were performed, and after the serum tumor markers level was in the normal or near-normal range, the residual tumors were completely resected.

Results

Residual tumors were confirmed in 11 of the 14 patients after NAT, and total removal was successful in 10 of the 11 patients. In the other patient the residual tumor could not be completely excised because it was attached to a deep vein. The follow-up duration ranged from 1.2 to 22.2 years. The 5-year event-free and total survival rates were 86% and 93%, respectively. Although 3 patients died, 2 of tumor recurrence and 1 of a radiation-induced secondary tumor (glioblastoma), the other 11 are alive and without evidence of tumor recurrence.

Conclusions

The authors consider their NAT protocol for NGMGCT to be highly effective in relation to survival for the patients with NGMGCT, but there are several quality of life issues that need to be resolved.

Abbreviations used in this paper:

AFP = α-fetoprotein; β-HCG = β-subunit of HCG; GCSF = granulocyte colony–stimulating factor; HCB = human chorionic gonadotropin; HRT = hormone replacement therapy; KPS = Karnofsky Performance Scale; NAT = neoadjuvant therapy; NGMGCT = nongerminomatous malignant germ cell tumor; QOL = quality of life.

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