Clinical features of patients with brain metastasis from testicular germ cell tumor

We retrospectively reviewed 190 patients with germ cell tumors of testis or extragonadal origin who were treated in our hospital between 1980 and 2007. Five (2.6%) of them had brain metastasis. We studied the clinical features and treatment outcome of these patients. Median age was 30 years old (23-48). The clinical stage was III in all the patients, except one with stage I disease. Two patients had brain metastasis at the initial presentation. All patients underwent multiple regimens of chemotherapy. As local therapies for brain metastases, surgical resection was done in 4 and gamma knife was in 1. Whole brain irradiation was added to surgery in 2 patients. All patients died of the disease within one year after brain metastasis development, except 1 patient who was free of disease 47 months after the presentation. The long survivor had solitary brain metastasis at the initial presentation and received 4 regimens of chemotherapy, 2 surgical resections of brain metastases and whole brain irradiation. Finally, chemotherapy consisting of irinotecan and nedaplatin resulted in normalization of the tumor markers and complete remission was proved by the subsequent surgical resection. Although most patients with brain metastasis have a poor clinical outcome, aggressive local treatment and employment of novel anticancerous agents may contribute to improve clinical course of selected patients with germ cell tumors and brain metastasis.