Primär mediastinale Keimzelltumoren – eine interdisziplinäre Herausforderung

Background: Primary mediastinal germ cell tumours (GCTs) originate from the upper anterior mediastinum. Their histology is similar to testicular germ cell cancers, but the prognosis is substantially worse. Objectives: An overview of pathophysiological characteristics, prognostic factors, and interdisciplinary management of primary mediastinal GCTs is provided. Materials and methods: The narrative review is based on a selective database search of PubMed, MEDLINE and current guidelines. Results: Primary mediastinal seminomas share the same prognosis and therapeutic approaches with all other advanced International Germ Cell Cancer Collaborative Group (IGCCCG)-intermediate risk seminomas. But mediastinal nonseminomas are often chemoresistant and have a substantially worse prognosis. To avoid treatment-associated pulmonary long-term sequelae omission of bleomycin and the use of cisplatin, etoposide and ifosfamide (VIP) is the preferred first-line chemotherapy choice. The German S3 guideline even recommends primary high-dose chemotherapy (HD-VIP). Complete secondary resection of all postchemotherapy residual masses irrespective of size should follow as histopathology often shows vital GCT components or mature teratoma with or without secondary malignant transformation. In case of relapse despite adequate multimodal first-line treatment, the prognosis is very poor. Conclusions: Successful treatment of primary mediastinal germ cell tumours is always an interdisciplinary clinical challenge and should only be performed at specialized centres.