Metastatic bone lesions are exceptional at diagnosis in germ trolled by systemic chemotherapy and locoregional radiation
cell tumors (GCTs). Bone involvement is usually a late event therapy. Solitary bone metastases from GCTs seem to be
combined with synchronous metastasis in the retroperitoneal chemosensitive and radiosensitive, but we do not know their
lymph nodes, lung and liver. Bone examination is not consid- prognostic value. We reviewed the literature where 3 similar
ered a standard procedure in the staging of GCTs, and this cases have been reported. We propose individualized man-
may contribute to underestimation of the real proportion of agement for symptomatic GCT patients including bone
bone metastases. Here we report a case of nonseminoma- scintigraphy and/or PET examination at diagnosis and a com-
tous GCT of the testis with a synchronous, symptomatic, bined cytotoxic approach with chemotherapy and radiation
solitary pubic bone metastasis that was completely con- therapy
Key words: bone metastasis, chemotherapy, nonseminomatous germ cell tumor, PET.
Correspondence to: Giovanni Benedetti, Medical Oncology, Hospital of Macerata, Via S. Lucia 1, 62100 Macerata, Italy.
Tel +39-0733-2572218; fax +39-0733-2572526; e-mail gbenedetti@asl9.marche.it
Received November 22, 2005; accepted March 29, 2006.
434 G BENEDETTI, F RASTELLI, M FEDELE ET AL
ment produced resolution of the pelvic pain, restoring area of intense hyperactivity in the left part of the
normal walking. The pelvic CT scan showed a reduc- sacrum and a faint uptake in the right ischiopubic ra-
tion of the pubic lesion, which was more evident in the mus (Figure 3A). A second line of chemotherapy was
soft tissue areas while there was persistent bone distor- planned starting from January 2004 with a combina-
tion (Figure 1B and 1C). Three months after the last tion of ifosfamide, carboplatin, and etoposide for 4 cy-
cycle of chemotherapy the patient complained of lower cles. A palliative dose (30 Gy) of radiation therapy was
back pain. A relapse was suspected but the tumor delivered to the sacral lesion. The patient obtained
markers were in the normal range, X-ray of the pelvis complete regression of the symptoms. The following
was negative, and CT scan showed that the residual PET examination confirmed the complete remission of
pelvic bone lesion was unchanged. Finally, positron the disease (Figure 3B). At present the patient is alive
emission tomography (PET) examination revealed an without disease.