Nine men and one woman with brain metastases from nonseminomatous germ cell tumors have been treated between 1977 and 1984. All the men had lung metastases. Nine patients had elevated serum values of human chorionic gonadotrophin (HCG), the level was greater than 40,000 IU/l in seven. They were treated with sequential combination chemotherapy either POMB/ACE or EP/OMB in which the methotrexate was given at a dose of 1 g/m2 and intrathecal methotrexate was given during courses not containing intravenous methotrexate. Eight of ten patients are alive, off treatment with no evidence of active disease, of whom five have been in remission and off treatment for more than 18 months. Two patients with primary intracranial nonseminomatous germ cell tumors were treated in a similar fashion. One patient died from enlargement of differentiated teratoma; the other is alive 9+ months off treatment with no evidence of disease. These results, which are better than any previously reported, indicate that chemotherapy is the preferred treatment of primary or metastatic nonseminomatous germ cell tumors of the brain and that only rarely will these patients benefit from surgery or radiotherapy.Cancer 57:2108-2113, 1986.HE TREATMENT of metastatic nonseminomatous T germ cell tumors has dramatically improved over the past 10 years, such that in specialist centers, over 80% are now becoming long-term survivors, probably cured. 1*2 Patients who present with brain metastases, however, have generally been considered to have a very poor prognosis. Approximately 2% to 3% of patients with disseminated testicular teratoms will present with brain metasta~es,~,~ while almost 40% of patients who die of progressive tumor will be found to have brain metastases at autopsy.s Improvements in therapy have reduced the number of patients who develop brain metastases in association with widespread drug resistant disease, but patients continue to present with brain metastases. Since the report from this unit in 19796 of the first successful treatment of a patient with brain metastases from a germ cell tumor, there have been several reports from other centers of longterm survivors after treatment for brain metastases, but