[Primary extragonadal germ cell tumors in man. 2. Therapy and prognosis]

Of the 23 males with primary extragonadal tumours of the germ cells observed from 1980 to 1989 9 males survived. These were 5 out of 14 primary retroperitoneal, 2 out of 5 primary mediastinal and 2 out of 4 primary intracranial tumours of the germ cells. Histologically in these cases were concerned 8 seminomas (among them 2 germinomas) and 1 primary retroperitoneal chorionepithelioma. The better prognosis of the seminomas is to be explained from the radiosensitivity and the higher chemosensitivity. The strategy of therapy was not always uniform, however, it made great efforts to reach the surgical removal of the tumour. Even in primary intracranial tumours of the germ cells this is the therapy of choice. The antineoplastic polychemotherapy following after this in retroperitoneal and mediastinal tumours of the germ cells was as a rule the PVB-schema according to Einhorn. In partial remission and non-response, respectively, various second-line schemes were used. At present a combination of cisplatin, etoposide and ifosfamide promises the best results, particularly when a bulky disease is existing. In seminomas the chemotherapy was followed as a rule by the locoregional telecobalt irradiation. Only the intracranial germinomas were irradiated postoperatively. A preventive telecobalt irradiation of the spinal canal should be taken into consideration in the individual case. An adjuvant antineoplastic polychemotherapy with 3 PVB-cycles was carried out in 2 patients with primary intracranial germinomas. They are in a permanent complete remission.