1
|
Cheng X, Yu H, Li J, Han X, Meng E, Zhou H, Wang D, Niu B, Zhang X. Dramatic response to local radiotherapy in a refractory metastatic mediastinal yolk sac tumor patient harboring a germline BRCA2 frameshift mutation: a case report. Cancer Biol Ther 2022; 23:393-400. [PMID: 35576916 PMCID: PMC9116401 DOI: 10.1080/15384047.2022.2072635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mediastinal yolk sac tumors (YSTs) are highly aggressive germ cell tumors with an extremely poor prognosis. Radiotherapy plays an important role in the treatment of mediastinal YSTs. To maximize benefit from radiotherapy in patients with mediastinal YSTs, exploring functionally relevant biomarkers is essential. Previous studies have demonstrated that mutations in DNA-damage repair (DDR) genes, including BRCA1/2, potentially enhance sensitivity to radiotherapy in solid tumors. However, DDR-gene mutations, as possible predictive biomarkers for radiotherapy in primary mediastinal YSTs, have not yet been reported. Herein, we report a 29-year-old male patient with a refractory metastatic primary YST involving a germline frameshift mutation in the BRCA2 gene (NM_000059.3: exon11: c.4563_4564delAT: L1522fs). During treatment alternation, the patient was found to respond poorly to chemotherapy with or without an immune checkpoint inhibitor but well to radiotherapy. Finally, the patient achieved approximately 17 months of overall survival. To the best of our knowledge, this case report is the first to describe a remarkable response to local radiotherapy in a patient with a refractory metastatic mediastinal YST involving a DDR-gene mutation (germline BRCA2 frameshift variation). This case report provides insightful clues for precision radiotherapy in clinical practice.
Collapse
Affiliation(s)
- Xi Cheng
- Department of Radiation Oncology, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| | - Haiming Yu
- Department of Radiation Oncology, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| | - Jinying Li
- Department of Radiation Oncology, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| | - Xiaona Han
- Department of Radiation Oncology, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| | - Erhong Meng
- Department of Scientific Research Project, ChosenMed Technology (Beijing) Co., Ltd, Beijing, China
| | - Houqing Zhou
- Department of Scientific Research Project, ChosenMed Technology (Beijing) Co., Ltd, Beijing, China.,Department of Medicine, ChosenMed Technology (Beijing) Co., Ltd, Beijing, China
| | - Dongliang Wang
- Department of Scientific Research Project, ChosenMed Technology (Beijing) Co., Ltd, Beijing, China.,Department of Medicine, ChosenMed Technology (Beijing) Co., Ltd, Beijing, China
| | - Beifang Niu
- Department of Scientific Research Project, ChosenMed Technology (Beijing) Co., Ltd, Beijing, China.,Computer Network Information Center, Chinese Academy of Sciences, Beijing, China.,School of Computer Science and Technology, University of the Chinese Academy of Sciences, Beijing, China
| | - Xiaotao Zhang
- Department of Radiation Oncology, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| |
Collapse
|
2
|
Germ Cell Tumor with Bronchial Fistula. Case Rep Radiol 2020; 2020:7650206. [PMID: 32181044 PMCID: PMC7066392 DOI: 10.1155/2020/7650206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/29/2019] [Accepted: 12/24/2019] [Indexed: 11/17/2022] Open
Abstract
Germ cell tumors account for 15% of anterior mediastinum tumors. Fistulas are abnormal communications between two surfaces covered by the epithelium. A fistula can occur between the bronchial tree and the adjacent anatomical structures secondary to variable etiologies. The main clinical manifestations of bronchial fistulas include hemoptysis, purulent cough, and pneumonia, which might threaten the patient's life. Diagnosis can be established with computed tomography, which shows direct and indirect signs of a fistulous tract. We present the case of a 25-year-old patient, with an embryonic carcinoma of the mediastinum, who developed a fistula between the mediastinal mass and the bronchial tree after chemotherapy and thoracic radiotherapy. We carried out a review of the literature about the epidemiological aspects and the physiopathology and the relevant radiological findings of this pathology.
Collapse
|
3
|
Neoadjuvant Bleomycin, Etoposide, and Cisplatin (BEP) Chemotherapy in the Treatment of Extensively Advanced Yolk Sac Tumors: A Single Center Experience. Int J Gynecol Cancer 2018; 28:713-720. [DOI: 10.1097/igc.0000000000001209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
ObjectiveThis study aimed to investigate the role of neoadjuvant bleomycin, etoposide, and cisplatin (BEP) regimen in patients with extensively advanced yolk sac tumors (YSTs).MethodsBetween July 1982 and December 2015, a total of 58 patients with YST were initially treated at our institution, among which 18 were evaluated to be inoperable and received neoadjuvant BEP regimen. They were either too debilitated by the disease [Eastern Cooperative Oncology Group Performance Status Scale (ECOG ps) ≥2] to undergo a major surgery or were with too extensively disseminated lesions to be optimally debulked. This cohort of patients was retrospectively reviewed.ResultsOne or 2 cycles of BEP regimen were prescribed to the majority of patients preoperatively. At the completion of neoadjuvant chemotherapy, 17 of them had ECOG ps of 1 or less. Seventeen (94.4%) exhibited clinical partial tumor regression, and 1 (5.6%) had clinical stable disease. Pathological complete tumor regression was observed in 2 (11.1%) patients, whereas the remaining 16 (88.9%) had nearly complete pathological regression. Seventeen patients were cytoreduced to no macroscopic residual disease; the remaining 1 was cytoreduced to macroscopic residual disease of 2 cm or less. No major surgical complications occurred. After a median follow-up of 83.5 months, 17 patients were free of recurrence. Five-year disease-free survival and overall survival were both 94.4%. Fertility-sparing surgery was carried out in all the 17 patients with the desire to preserve their fertility, and 5 infants were delivered in 6 patients who attempted conception.ConclusionsOne or 2 cycles of neoadjuvant BEP regimen followed by cytoreductive surgery offer a chance for cure in extensively advanced patients with YSTs and help pave the way for fertility-sparing surgery.
Collapse
|
4
|
Liu B, Lin G, Liu J, Liu H, Shang X, Li J. Primary mediastinal yolk sac tumor treated with platinum-based chemotherapy and extended resection: Report of seven cases. Thorac Cancer 2018; 9:491-494. [PMID: 29318787 PMCID: PMC5879052 DOI: 10.1111/1759-7714.12591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/09/2017] [Accepted: 12/09/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Primary mediastinal yolk sac tumor, which is also known as endodermal sinus tumor, is a rare but lethal neoplasm, and it is a kind of mediastinal non-seminomatous germ cell tumor. The current standard treatment in mediastinal non-seminomatous germ cell tumors is chemotherapy combined with postchemotherapy residual mass resection. We report on seven cases of primary mediastinal yolk sac tumor treated with platinum-based chemotherapy and extended resection. METHODS We experienced seven cases of primary mediastinal yolk sac tumor between August 2014 and August 2017. All cases had markedly raised α-fetoprotein and normal β-human chorion gonadotropin. Computed tomography scan revealed an anterior mediastinal tumor in all cases. Five patients underwent needle core biopsy, which showed a mediastinal yolk sac tumor. They received preoperative platinum-based chemotherapy and then underwent extended resection, and four of them received postoperative platinum-based chemotherapy. Two other patients did not receive preoperative biopsy, and they underwent surgical extended resection and then received postoperative platinum-based chemotherapy. RESULTS Two patients (29%) experienced a postoperative complication, including one pneumonia and one atelectasis. There were no operative deaths. R0 resection was achieved in six patients (86%), and R2 resection was achieved in the other patient. Three patients experienced pulmonary metastases within one year, and two of them soon died. Four other patients were alive without recurrence at the time of writing. CONCLUSION Primary mediastinal yolk sac tumor is rare, and the prognosis is poor. A multimodality aggressive approach including adjuvant chemotherapy followed by surgical resection is the optimal treatment and may lead to long-term survival.
Collapse
Affiliation(s)
- Bing Liu
- Department of Thoracic Surgery, Peking University First Hospital, Peking University, Peking, China
| | - Gang Lin
- Department of Thoracic Surgery, Peking University First Hospital, Peking University, Peking, China
| | - Jingwei Liu
- Department of Thoracic Surgery, Peking University First Hospital, Peking University, Peking, China
| | - Haibo Liu
- Department of Thoracic Surgery, Peking University First Hospital, Peking University, Peking, China
| | - Xueqian Shang
- Department of Thoracic Surgery, Peking University First Hospital, Peking University, Peking, China
| | - Jian Li
- Department of Thoracic Surgery, Peking University First Hospital, Peking University, Peking, China
| |
Collapse
|
5
|
Surgery for malignant lesions of the chest which extensively involved the mediastinum, lung, and heart. Gen Thorac Cardiovasc Surg 2017; 65:365-373. [PMID: 28540630 DOI: 10.1007/s11748-017-0782-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/10/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Radical resection for thoracic malignancies that invade the great vessels or heart structure is an uncommon, high-risk operation. To help surgeons determine therapeutic strategy, we reviewed the patient characteristics and outcomes of combined thoracic and cardiovascular surgery for thoracic malignancies. METHODS Surgical resections of lung cancer, mediastinal tumor and pulmonary artery sarcoma invading great vessels or heart structures were reviewed from the literature. RESULTS Pneumonectomy was often performed for lung cancer invading the aorta, superior vena cava, and left atrium. Complete resection (R0), no mediastinal lymph node metastasis and without using cardiopulmonary bypass led to a good prognosis. Induction therapy was often performed for complete resection. Regarding mediastinal tumors, thymic epithelial tumors or germ cell tumors occasionally invaded the great vessels or heart structures. For these malignancies, multimodality therapy was often performed, and complete resection could be one of the prognostic factors. The resection of primary pulmonary artery sarcoma (PPAS) is also a combined thoracic and cardiovascular surgery. The primary treatment for PPAS is surgical resection; specifically, pulmonary endarterectomy and pneumonectomy, because PPAS has substantial resistance to chemotherapy or radiotherapy. The prognosis of PPAS is poor, but surgical resection has potential for long-term survival. CONCLUSION Although these surgeries are uncommon and invasive for the patients, selecting appropriate patients, aggressive multimodality therapy, and performing combined thoracic and cardiovascular surgery can contribute to a good outcome.
Collapse
|
6
|
Tumeurs germinales primitives du médiastin : expérience de l’Institut de cancérologie de Lorraine sur une période de 20 ans (1990-2012). Bull Cancer 2014; 101:1067-73. [DOI: 10.1684/bdc.2014.2047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
7
|
Kuwano H, Tsuchiya T, Murayama T, Sano A, Nagayama K, Yoshida Y, Murakawa T, Nakajima J. Outcomes of combined modality therapy for patients with stage III or IV mediastinal malignant germ cell tumors. Surg Today 2013; 44:499-504. [PMID: 23553421 DOI: 10.1007/s00595-013-0562-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 01/16/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE The treatment of primary mediastinal germ cell tumors with cisplatin-based chemotherapy followed by surgery is an established practice; however, the prognosis has remained poor. This study reviews the survival outcomes of patients with primary mediastinal germ cell tumors to evaluate the efficacy of our treatment. METHODS We retrospectively reviewed 11 consecutive patients with primary mediastinal germ cell tumors. RESULTS We had treated four patients with seminomas and seven patients with non-seminomas. Ten patients had undergone cisplatin-based chemotherapy. All patients underwent complete resection. Two patients showed a failure of first-line chemotherapy and thus received salvage chemotherapies, including paclitaxel plus ifosfamide followed by high-dose carboplatin plus etoposide (TI-CE) with stem cell transplantation. One of them died of relapse 29 months later; while the other patient remained disease-free for 56 months postoperatively. The postoperative overall 3-year survival rates of the patients with non-seminomas and seminomas were 83 and 100%, respectively. CONCLUSION Complete resection after establishing normalized or decreased at a low-level serum tumor markers plateau plays a crucial role in the management of patients with primary mediastinal malignant germ cell tumors.
Collapse
Affiliation(s)
- Hideki Kuwano
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan,
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Liu TZ, Zhang DS, Liang Y, Zhou NN, Gao HF, Liu KJ, Wu HY. Treatment strategies and prognostic factors of patients with primary germ cell tumors in the mediastinum. J Cancer Res Clin Oncol 2011; 137:1607-12. [PMID: 21850383 PMCID: PMC3193517 DOI: 10.1007/s00432-011-1028-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 07/28/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical characteristics and survival outcomes of patients with primary mediastinal germ cell tumor (PMGCT) by identifying the prognostic factors and efficacies of different treatment modalities. METHODS Fifty-five patients with PMGCT who were treated consecutively at Cancer Center, Sun Yat-sen University, Guangzhou, from 1988 to 2010 were evaluated retrospectively. RESULTS Fifty-two men and 3 women with a median age of 25 years were identified, of whom 17 (30.9%) had pure seminomatous, 38 (69.1%) had nonseminomatous histology, 27 (49.1%) had tumor located at mediastinum, 20 (36.4%) had lung metastases and/or effusions, and 8 (14.5%) had distant metastases. Three treatments surgery, chemotherapy, and radiotherapy were performed in 11 (20%) patients, two treatments chemotherapy plus surgery or radiotherapy were performed in 25 (45.6%), and single treatment surgery or chemotherapy was performed in 17 (30.9%). The other two patients (3.6%) received no treatment. After a median follow-up time of 31.4 months, the 5-year survival rate was 52%. The median overall survival time was 87.9 months. Patients who received two treatments had the longest survival time of 118.3 months, P = 0.000. Those who had pure seminoma histology, whose tumor confined to the mediastinum and who achieved complete or partial remission at initial evaluation, who had complete resection and radiotherapy were considered to have better prognosis according to univariate analysis. On multivariate analysis, extension and response rate at initial evaluation were independently predictive of survival. CONCLUSIONS Primary mediastinal germ cell tumor is rare with a dominant frequency in young male patients. Chemotherapy combined with local therapy like surgery or radiotherapy is a reasonable treatment strategy recommended. Extension and initial remission rate are independent prognostic factors.
Collapse
Affiliation(s)
- Ting Zhi Liu
- Cancer Center, Sun Yat-Sen University, No.651, Dongfeng Rd., Guangzhou, 510060 Guangdong Province China
| | - Dong Sheng Zhang
- Cancer Center, Sun Yat-Sen University, No.651, Dongfeng Rd., Guangzhou, 510060 Guangdong Province China
| | - Ying Liang
- Cancer Center, Sun Yat-Sen University, No.651, Dongfeng Rd., Guangzhou, 510060 Guangdong Province China
| | - Ning Ning Zhou
- Cancer Center, Sun Yat-Sen University, No.651, Dongfeng Rd., Guangzhou, 510060 Guangdong Province China
| | - Hong Fei Gao
- Cancer Center, Sun Yat-Sen University, No.651, Dongfeng Rd., Guangzhou, 510060 Guangdong Province China
| | - Ke Jun Liu
- Cancer Center, Sun Yat-Sen University, No.651, Dongfeng Rd., Guangzhou, 510060 Guangdong Province China
| | - Hai Ying Wu
- Cancer Center, Sun Yat-Sen University, No.651, Dongfeng Rd., Guangzhou, 510060 Guangdong Province China
| |
Collapse
|