Primary Mediastinal Germ Cell Tumors: A Real-World Analysis of Clinical Characteristics, Treatment, and Survival Outcomes From Two Tertiary Cancer Centers in India

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Abstract
PURPOSE: Mediastinal germ cell tumors (GCTs) are rare malignancies, predominantly affecting young males, with limited real-world data on treatment outcomes in India. This study aimed to evaluate the clinical characteristics, treatment patterns, and survival outcomes of patients with mediastinal GCTs, emphasizing the effectiveness of first-line chemotherapy regimens. METHODS: A retrospective analysis was conducted on 81 patients diagnosed with mediastinal GCTs at two tertiary cancer centers in India from 2005 to 2023. Data on demographics, histological subtypes, presenting symptoms, treatment regimens, and outcomes were collected. Kaplan-Meier analysis was used to calculate progression-free survival (PFS) and overall survival (OS). RESULTS: The median age at diagnosis was 26 years, with a male predominance (96.3%). Common histological subtypes included seminoma (34.3%) and yolk sac tumor (31.3%). First-line chemotherapy comprised bleomycin, etoposide, and cisplatin (BEP; 60.5%) and etoposide, ifosfamide, and cisplatin (VIP; 27.8%). Response rates included complete response (25.3%) and partial response (54.4%). After a median follow-up of 15 months, the median PFS and OS were not reached, with 2-year PFS and OS rates of 92.7% and 93.3%, respectively. Seminomas demonstrated better PFS compared with nonseminomatous GCTs ( P = .004). Severe toxicities were observed in 48.1% of patients, with febrile neutropenia being the most common. CONCLUSION: This study highlights the effectiveness of BEP and VIP chemotherapy in achieving high response rates and favorable survival outcomes in mediastinal GCTs. Early diagnosis, appropriate histological classification, and aggressive multimodal treatment strategies are essential for improving long-term outcomes in this predominantly young patient population. Further research is warranted to validate these findings and optimize therapeutic approaches.

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