Brain metastases (BM) of nonseminomatous germ cell tumors (NSGCT): What population of patients should be screened?

Abstract

e15583 Background: BM from NSGCT present in 5-15% of pts with metastatic disease. There is no uniform consensus what population of pts with NSGCT should be screened for BM. Methods: Among 1700 pts with metastatic GCT who were treated in our center from 1990 to 2009 we identified 20 (1.1%) pts with BM: 11 pts had BM at initial presentation. No pts with BM of seminoma were identified. The minimal f.-up time after the end of treatment was 24 months. None of 9 pts with BM at relapse had brain imaging initially and 6 (67%) had BM as the only site of relapse. Since 2005 we have started routine brain MRI for all new pts with hCG level above 50000 IU/l. BM were found in 4 (14%) of 28 those pts, incl. 3 pts with asymptomatic BM. Before 2005 there were 38 pts with hCG level above 50000 IU/l and BM were seen in only 3 (7,9%) pts, who had specific symptoms. For further analysis we combined pts with initially presented BM (n=11) and pts who had BM as the only site of relapse (n=6), because in later group BM were obviously missed before 1-st line of chemotherapy. Results: Factors associated with BM were multiple (n>3) pulmonary mets >2cm - all 17 pts, IGCCCG poor prognosis -13 (76%) pts, initial hCG > 50000 IU/l - 9(53%) pts. Among 43 pts with multiple pulmonary mets and hCG > 50000 IU/l 9 (21%) pts had BM: sensitivity 53%, specificity 93%, PPV 21%, NPV 98%. Screening of BM in this population would miss 47% of them. Among 142 pts with multiple pulmonary mets and intermediate or poor IGCCCG prognosis 17 (12%) pts had BM: sensitivity 100%, specificity 76%, PPV 12%, NPV 100%. Conclusions: Pts with elevated hCG level above 50000 IU/l and multiple (n>3) pulmonary mets >2cm have high incidence (21%) of BM. Brain imaging of pts with multiple (n>3) pulmonary mets >2cm and intermediate or poor IGCCCG prognosis is recommended.