In a patient with primary mediastinal seminoma with normalization of biomarkers s/p EPx4 and residual non-FDG avid mass, would you consider resection of residual tumor vs surveillance?  

Patients with a primary mediastinal seminoma will have > 90% cure rate with chemo alone, but will ALWAYS have a residual mass. Assuming the initial serum AFP was normal and pathology was definitive that this was ONLY seminoma, we would not even do a PET scan but just observe with serial CT scans,...

This should be a good risk situation assuming there is no extra-mediastinal disease and the cure rate with primary therapy should be high. My own opinion is that such patients should receive standard therapy for this setting which is BEP X 3 (Based on the French randomized trial of BEP X 3 vs EP X 4...