Brain Metastases from Testicular

Germ Cell Tumors: A

Retrospective Analysis
dr F H Pranata (MIB)
Urologi
Introduction
• Testicular germ cell tumors (TGCT) accounting for about 1%
malignancies in men in USA
• Most in 15-35 years
• TGCT is chemosensitive
• The International Germ Cell Consensus Classification (IGCCC)
estimates prognoses according to risk criteria
• Brain metastases is relative rare, its about 1-2% TGCT
Introduction
• According to IGCCC belong to poor prognosis group
• Brain metastases can occur in initial diagnoses or during treatment
• Brain metastases present a therapeutic challenge because its
relevance with BBB
Methods
• From 1994-2007, 27 patients with brain metastases at Osaka
University Hospital, Osaka Medical Center, and Kyoto Prefectural
University Hospital were reviewed retrospectively
• 10 patients had brain metastases at initial diagnoses (initial cases)
• 17 patients developed during treatment (subsequent cases)
• 26 patients had non-seminoma GCT, 1 patients had seminoma GCT
• 18 patient belong to poor prognosis group, 7 intermediate prognosis
group, 2 good prognosis group
TNM Classification and Staging
Patient Characteristics
Treatment Outcomes
Results
• 14 patients died of cancer (three treatment related deaths, case 6, 8,
16)
• 1 patient alive with tumor, 9 alive with no evidence of disease
• 10 initial cases, 5 were disease-free
• 17 subsequent cases, 3 were disease-free
• Initial cases tended to live longer than subsequent cases
• 27 patients received chemotherapy
Results
• 3 patients  chemotherapy only
• 10 patients  chemotherapy + WBRT
• 6 patients  chemotherapy + SRT
• 3 patients  chemotherapy + WBRT + SRT
• 3 patients  chemotherapy + WBRT + surgery
• 1 patients  chemotherapy + SRT + surgery
• 1 patients  chemotherapy + surgery
Results
Results
Discussion
• Metastatic brain tumors are the most common tumor in intracranial
malignancies
• 5 and 10 DSS rate were both 35.9%
• Routine MRI or Brain CT is not recommended in the absence of
neurological sign and symptoms
• If tumor markers do not normalize during chemotherapy, possibility
of brain metastases should be kept in mind
• 3 patients from chemotherapy alone group  1 alive and disease-
free
Discussion
• In few patients, brain metastases didn’t respond to chemotherapy
• Cisplatin, bleomycin, and etoposide cross the BBB
• High dose chemotherapy may improve the outcome
• Chemotherapy cannot be omitted for TGCT with brain metastases
• SRT should be performed in isolated brain metastases that are fewer
than four in number
• WBRT performed in brain micrometastases
Discussion
• Radiotherapy had an impact on survival in subsequent cases
• Neurosurgery also improved survival
• Survival of multiple brain metastases was poorer
Conclusion
• Providing definitive guideline for brain metastases of TGCT is difficult
on this clinical series
• MRI or CT should be performed in TGCT patients with neurological
sign and symptoms or tumor markers didn’t normalize after
chemotherapy
• TGCT patients with brain metastases should undergo multidiscipline
approach
• Patients should undergo multimodal treatment especially in
subsequent cases