title: Therapeutic dilemma of disseminated CNS germinoma and the potential of increased platinum-based chemotherapy delivery with osmotic blood-brain barrier disruption.
abstract: In contrast to disseminated extraneural germinoma, systemic chemotherapy in disseminated central nervous system germinoma often results in only transient responses. After surgery, cytoreduction was accomplished with systemic multiagent platinum-based chemotherapy in 4 consecutive patients known to have a poor prognosis, due to central nervous system germinoma at more than one anatomic site. When tumor enhancement resolved (i.e., blood-brain barrier integrity was restored), intensive consolidation therapy with carboplatin and etoposide was given in association with mannitol-induced osmotic blood-brain barrier disruption. Complete responses occurred in all 4 patients and currently 3 are tumor-free without radiotherapy 24-40 months from diagnosis, suggesting the importance of increased drug delivery for an extended period.
authors.affiliation: Oregon Health Sciences University, Portland 97201-3098.
authors.forename: E A
authors.initials: EA
authors.lastname: Neuwelt
authors.forename: P C
authors.initials: PC
authors.lastname: Wiliams
authors.forename: B E
authors.initials: BE
authors.lastname: Mickey
authors.forename: E P
authors.initials: EP
authors.lastname: Frenkel
authors.forename: W D
authors.initials: WD
authors.lastname: Henner
mesh_terms: D000293:Adolescent; D000328:Adult; D001812:Blood-Brain Barrier; D001921:Brain / Q000473:pathology*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D016190:Carboplatin / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use*; D005047:Etoposide / Q000627:therapeutic use*; D005260:Female; D018237:Germinoma / Q000188:drug therapy* / Q000473:pathology*; D006316:Hearing Loss, High-Frequency / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008353:Mannitol / Q000008:administration & dosage / Q000627:therapeutic use*; D010984:Platinum / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D008353:Mannitol; D010984:Platinum; D005047:Etoposide; D016190:Carboplatin; D002945:Cisplatin