Is the blood-brain barrier relevant in metastatic germ cell tumor?
OBJECTIVE
Germ cell tumors are uniquely chemosensitive and curable, even with advanced metastatic disease. Central nervous system recurrence can terminate a complete remission in other chemosensitive tumors, such as small cell lung cancer, because of the blood-brain barrier (BBB). We propose to document that the BBB is also relevant in germ cell tumors despite their dramatic chemosensitivity.


METHODS
We present five cases illustrating the concept of the BBB in patients with metastatic testicular cancer treated with chemotherapy.


RESULTS
In our large series of patients with metastatic testicular cancer treated with chemotherapy, we identified 5 unique patients. These patients were rendered free of disease only to experience relapse in the brain alone. This included 1 patient who initially had good-risk metastatic disease by means of the International Germ Cell Collaborative Group staging system at the onset of chemotherapy.


CONCLUSIONS
The BBB is relevant in patients with metastatic testicular cancer.
Azar
Jose M
JM
Department of Medicine, Division of Hematology and Oncology, Indiana University, Indianapolis, IN, USA. jazar@iupui.edu
Schneider
Bryan P
BP
Einhorn
Lawrence H
LH
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D001812:Blood-Brain Barrier; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D016371:Cranial Irradiation / Q000379:methods; D005047:Etoposide / Q000008:administration & dosage; D017809:Fatal Outcome; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary*; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000601:surgery
D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin