The management of brain metastasis in nonseminomatous germ cell tumours

Mahalati, Kamran; Bilen, Cenk Yücel; Özen, Haluk; Aki, Fazıl Tuncay; Kendi, Sezer

doi:10.1046/j.1464-410x.1999.00967.x

Cited by 27 publications

(16 citation statements)

References 15 publications

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“…However, these features may merely indicate a poor prognostic group in whom CNS metastases are more likely. Brain metastases from NSGCT usually occur in the presence of metastases elsewhere, particularly the lungs, prompting the suggestion that cerebral imaging should be performed in patients with bulky lung disease to detect asymptomatic CNS involvement [1, 2]. …”

Section: Discussionmentioning

confidence: 99%

“…There have been no randomised prospective trials that have compared different treatment approaches for patients with NSGCTs and CNS metastases [1]. If CNS metastases develop in the context of progressive systemic disease despite treatment, patients are unlikely to achieve cure and are usually offered palliative radiotherapy [2].…”

Section: Discussionmentioning

confidence: 99%

“…If CNS metastases develop in the context of progressive systemic disease despite treatment, patients are unlikely to achieve cure and are usually offered palliative radiotherapy [2]. On the other hand, for patients with CNS metastases at diagnosis or those with isolated CNS relapse, cure or long-term survival is possible, although optimal management could be different for these two patient groups [1]. …”

Section: Discussionmentioning

confidence: 99%

“…Central nervous system (CNS) metastases are found in 2–3% of all patients with non-seminomatous germ cell tumours (NSGCTs) of the testis at presentation [1, 2], but more commonly are associated with progressive systemic disease. Overall, CNS metastases occur in up to 15% of patients with NSGCTs of the testis, although autopsy series have reported a higher incidence of up to 40% [1, 2, 3].…”

Section: Introductionmentioning

confidence: 99%

“…Overall, CNS metastases occur in up to 15% of patients with NSGCTs of the testis, although autopsy series have reported a higher incidence of up to 40% [1, 2, 3]. Isolated CNS relapse (defined as the presence of one or more cerebral metastases without evidence of disease elsewhere) is very rare and has only been reported in 12 cases previously [1, 3, 4, 5, 6](table 1). …”

Section: Introductionmentioning

confidence: 99%

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Isolated Central Nervous System Relapse of Non-Seminomatous Germ Cell Tumour of the Testis

Cohn¹,

Stuart-Harris²

2001

Oncology

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Isolated central nervous system (CNS) relapse of non-seminomatous germ cell tumour (NSGCT) of the testis has been reported in only 12 patients previously. We report a patient with an isolated CNS relapse of NSGCT, following a prior systemic relapse. From a review of previous cases, isolated CNS relapse appears to be more common in patients with embryonal cell histology (alone or mixed with other elements) and occurred after a median of 8.5 months following initial presentation. Long-term survival appears possible using multi-modal treatment with whole-brain radiotherapy, surgery and/or chemotherapy. However, the optimal treatment of isolated CNS relapse remains undefined.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Isolated Central Nervous System Relapse of Non-Seminomatous Germ Cell Tumour of the Testis

Cohn¹,

Stuart-Harris²

2001

Oncology

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Brain metastases associated with germ cell tumors may be treated with chemotherapy alone

Hardt

Krell

Wilson

et al. 2014

Cancer

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BACKGROUND:The management of brain metastases in patients with germ cell tumors remains controversial. The authors assessed the outcome in this patient group after the introduction of GAMEC chemotherapy (14-day cisplatin, high-dose methotrexate, etoposide, and actinomycin-D with filgrastim support) and cessation of the routine use of cranial irradiation. METHODS: Data were recorded prospectively from 39 patients with germ cell tumors and concurrent brain metastases who received treatment before and after the advent of GAMEC after they relapsed on conventional cisplatin-based chemotherapy. Neurosurgery was offered to selected patients. Radiotherapy generally was used only as a salvage therapy after chemotherapy failure. The primary outcome measure was overall survival and was depicted using a Kaplan-Meier plot. RESULTS: The 3-year overall survival rates were 38% for the whole cohort, 69% for those who presented with brain metastases at diagnosis (group 1), and 21% and 0% for those who developed metastases after initial chemotherapy (group 2) and while receiving chemotherapy (group 3), respectively. For the whole cohort, the median overall survival was 10.6 months (range, 5.5 months to not evaluable); and, for groups 1, 2, and 3 individually, the overall survival was not yet reached (range, from 7.4 months to not evaluable), 6.2 months (range, 2.1-15.3 months), and 2.7 months (range, from 0.6 months to not evaluable), respectively. The 3-year survival rate for those who received GAMEC chemotherapy was 56% compared with 27% for those who received chemotherapy pre-GAMEC. CONCLUSIONS: The prognosis for patients with germ cell tumors and brain metastases seems less bleak than previously thought. It is possible to achieve long-term survival with chemotherapy alone. INTRODUCTIONGerm cell tumors are among the most common cancers in young men.1 The prognosis for patients with advanced germ cell tumors can be estimated according to the risk criteria set out by the International Germ Cell Consensus Classification.1 Patients with good-prognosis disease have a 5-year survival rate >90%, but this falls to approximately 50% for those in the poor-risk group. Patients with nonpulmonary visceral metastases, which include brain metastases, fall into the poor-prognosis group, but the 5-year survival rates for patients with brain metastases appears to be worse than the rates for others within this group: 33% compared with 35% for those with bone metastases and 49% for those with liver metastases.1 Brain metastases occur in approximately 10% of patients who have advanced, metastatic germ cell tumors. They are present in approximately 3% of patients at diagnosis, but autopsy studies indicate that this rises to 40% in patients who die from the disease.

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Metastases to the Central Nervous System

2002

TxNxM1

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The management of brain metastasis in nonseminomatous germ cell tumours

Cited by 27 publications

References 15 publications

Isolated Central Nervous System Relapse of Non-Seminomatous Germ Cell Tumour of the Testis

Isolated Central Nervous System Relapse of Non-Seminomatous Germ Cell Tumour of the Testis

Brain metastases associated with germ cell tumors may be treated with chemotherapy alone

Metastases to the Central Nervous System

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