Successful Treatment of Primary Mediastinal Seminoma With Radiotherapy Following Chemotherapy Under a Bloodless Treatment Policy Based on Patient's Religious Sentiments

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Abstract
Introduction: Primary mediastinal seminoma is rare with a favorable prognosis when appropriately treated, and surgical resection after chemotherapy is the standard treatment. However, refusal of blood transfusion for religious reasons can limit curative surgical management. Case Presentation: A 47‐year‐old Jehovah's Witness man was found to have a 10.8‐cm anterior mediastinal tumor. Biopsy confirmed seminoma. As the patient refused transfusion, definitive chemotherapy followed by radiotherapy was selected. Three cycles of chemotherapy (etoposide, ifosfamide, and cisplatin) resulted in 44% tumor reduction and partial response. Intensity‐modulated radiotherapy of the residual tumor (36 Gy in 20 fractions) achieved complete response, maintained for 11 months without recurrence or late toxicity. Conclusion: Sequential chemotherapy followed by consolidative radiotherapy appeared to be a safe and effective option for primary mediastinal germ cell tumor in the short term when surgical resection was not feasible for religious reasons.

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