Management of Mediastinal Seminoma: Mediastinal seminoma is histologically identical to its gonadal counterpart and these tumors share the unique radiosensitivity of testicular seminoma. For many years, primary therapy consisted of a megavoltage irradiation to the mediastinum. Such an approach results in a 60 to 80 percent long-term survival. Despite these generally favorable outcomes in patients with mediastinal seminoma, the presence of certain clinical features and experience with chemotherapy in seminoma has called for review of the policy of radical radiotherapy for all patients with mediastinal seminoma. First, these tumors can be very bulky at presentation with invasion into adjacent intrathoracic structures and extension to the hila and lung parenchyma. Encompassing such large volume disease within a radiotherapy port is difficult and can result in excessive irradiation of normal lung and mediastinal structures. Second, while local control is usually obtained with radiotherapy, 20 to 40 percent of patients will ultimately fail at distant sites. proventil inhaler
The emerging role of chemotherapy in advanced gonadal seminoma has led several investigators to employ cisplatin-based chemotherapy as primary treatment to patients with extragonadal seminoma. Jain and colleagues at Memorial Sloan Kettering Cancer Center report a complete remission rate of 100 percent (seven of seven) in patients with mediastinal seminoma utilizing cisplatin-based therapy.
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