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Background Primary malignant germ cell tumors (GCTs) of mediastinum are rare neoplasms.We introduce our institutional experience in managing patients with primary malignant GCTs of the mediastinum,focusing on the analysis of therapeutic modalities.Methods A retrospective review was done in 39 consecutive patients with mediastinal malignant GCTs treated in our institution between 1991 and 2007.Results A total of 39 patients were enrolled in this study with a median age of 27 years.The 5-year overall survival (OS) and progression-free survival (PFS) rates of the whole population were 60.2％ and 57.7％,respectively.Stratified by the histology,18 patients (46.2％) had seminoma and 21 patients (53.8％) had nonseminomatous germ cell tumors (NSGCTs).The 5-year OS rate of patients with seminoma was 87.4％ as compared with 36.7％ in patients with NSGCTs (P=-0.0004).The 5-year PFS rate was also significantly higher in seminoma patients (87.4％ vs.31.6％,P=-0.003).For 19 patients with NSGCTs managed with multi-modality treatment,chemotherapy exposure appeared to impact the prognosis.The 5-year OS rate was 44.9％ in patients with chemotherapy exposure as compared with 20.0％ in patients without it (P=0.43).Conclusion Our study confirmed the significance of systemic chemotherapy in the treatment of primary mediastinal GCTs.