Brain as sanctuary site of relapse in germ cell cancer patients previously treated with chemotherapy.
BACKGROUND
Post chemotherapy isolated relapse to the brain of germ cell cancer is potentially curable.


METHODS
We reviewed the experience of germ cell cancer with cerebral metastases at the CRC Wessex Medical Oncology Unit in Southampton. Patients were classified according to their presentation (initial diagnosis, solitary relapse or widespread). Treatment and outcome of these patients is presented and compared with previous series.


RESULTS
Of 1049 patients treated for metastatic germ cell cancer, 15 were diagnosed with cerebral metastases. Six patients had cerebral sanctuary site relapse, and underwent resection and cranial irradiation. Four of these are continuously disease free after treatment at 2, 67, 96, and 145 months from therapy, another is receiving chemotherapy for limited systemic relapse and the sixth has relapsed and died. Three further patients relapsed with cerebral disease in the presence of active disease elsewhere and each progressed and died. The final six patients had cerebral disease at presentation of whom five have progressed and died.


CONCLUSIONS
Isolated cerebral metastases occurring after successful systemic chemotherapy for germ cell cancer are curable. An aggressive salvage approach with surgery followed by radiotherapy is indicated.
CRC Wessex Medical Oncology Unit, Royal South Hants Hospital, Southampton, UK.
S J
SJ
Crabb
J J
JJ
McKendrick
G M
GM
Mead
D000328:Adult; D001932:Brain Neoplasms / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D006063:Chorionic Gonadotropin / Q000032:analysis; D018237:Germinoma / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology*; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis
D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins