Successful treatment of mediastinal germ cell/endodermal sinus tumors

Three patients with endodermal sinus tumor of the mediastinum and two with endodermal sinus tumor mixed with other histologies were treated with CEBA (cisplatin, etoposide, bleomycin, and doxorubicin [Adriamycin]) and by cytoreductive surgery. Three patients treated with CEBA followed by surgery achieved a complete remission and remain free of disease at 36+, 35+, and 28+ months, respectively, from diagnosis. Two patients were treated initially with vinblastine, bleomycin, cisplatin, and surgery, and neither achieved a complete remission. Both then received CEBA, and one achieved a complete remission (duration 47 + months). Bone marrow toxicity from CEBA was severe, abrupt, and cumulative. All patients experienced neutropenic fever, anemia, and thrombocytopenia requiring platelet transfusions. The CEBA followed by vigorous cytoreductive surgery is effective treatment for germ cell tumors of the medastinum containing endodermal sinus tumor elements.