Brain metastases from testicular germ cell tumors: A retrospective analysis

Abstract

Objectives: To review our series of testicular germ cell tumors with brain metastases and to establish an optimal treatment strategy for them. Methods: Twenty-seven cases of testicular germ cell tumors from three institutions were retrospectively reviewed. Results: Twenty-six were non-seminomatous tumors and only one was a seminoma. Based on the International Germ Cell Consensus Classification, two cases were classified as good prognosis, seven as intermediate prognosis and 18 as poor prognosis. Chemotherapy was carried out in all patients. Additionally, whole-brain radiotherapy was performed in 10 cases, stereotactic radiosurgery in six, whole-brain radiotherapy combined with stereotactic radiosurgery in three and complete surgical resection in five. Three patients received chemotherapy only. Cancer-specific 5-and 10-year survival rates were both 35.9%. The prognosis of those with brain metastases at the time of diagnosis tended to be better than those developing brain metastases during treatment. Those with a single brain metastasis showed significantly better survival than those with multiple brain metastases. No other significant prognostic factor was found at multivariate analysis. Conclusion: Testicular germ cell tumors with brain metastases can be managed with the combination of whole-brain radiotherapy, stereotactic radiotherapy, and/or surgical resection in combination with chemotherapy.

Management of Brain Metastases from Germ Cell Tumors: A Single Center Experience

“…For patients with brain metastasis at initial diagnosis, 2-year survival rates range from around 30 to 54% and median survival from 15 to 56 months in the different series [8,9,10,11,12]. In these series, most of the patients were treated with upfront chemotherapy.…”

“…In most series, patients were treated with radiotherapy with or without chemotherapy [8,9,10,11,12]. …”

Inzidentelles undifferenziertes Karzinom der Prostata

“…Die Metastasierung von Seminomen erfolgt in der Regel lymphatisch in die retroperitonealen Lymphknoten oder hämatogen vorwiegend in Lunge und Leber. Sehr selten können häma-togene Seminommetastasen fast ubiquitär auftreten, beispielsweise auch in der Prostata [3,4,5,6]. Bislang wurden in der Literatur nur 4 weitere Fälle von Seminommetastasen in der Prostata beschrieben (.…”

Use of the Graded Prognostic Assessment (GPA) score in patients with brain metastases from primary tumours not represented in the diagnosis-specific GPA studies

“…Author Population Significant prognostic factors Sehouli et al [19] Ovarian cancer, n = 74 KPS, number of brain metastases, histological grade, platinum sensitivity (multivariate) Cohen et al [2] Ovarian cancer, n = 72 Aggressive local treatment Growdon et al [6] Gynaecological cancers, n = 30 Extracranial disease, histology, use of chemotherapy (multivariate) Fokas et al [4] Bladder cancer, n = 62 Extracranial metastases, RPA class Rades et al [15] Bladder cancer, n = 33 Multivariate analysis revealed no significant prognostic factors Tremont-Lukats et al [24] Prostate cancer, n = 103 Adenocarcinoma vs other histology Nonomura et al [12] Testicular germ cell tumours, n = 27 Single brain metastasis (multivariate) Salvati et al [18] Sarcoma, n = 35 KPS, complete en-bloc surgery Rades et al [13] Unknown primary, n = 101 KPS, extracranial metastases, RPA class Bartelt and Lutterbach [1] Unknown primary, n = 47 KPS, surgical resection status (multivariate) Ruda et al [16] Unknown primary, n = 33 Number of brain metastases (multivariate)…”