Brain metastases from testicular germ cell tumors: a retrospective analysis.
OBJECTIVE
To review our series of testicular germ cell tumors with brain metastases and to establish an optimal treatment strategy for them.


METHODS
Twenty-seven cases of testicular germ cell tumors from three institutions were retrospectively reviewed.


RESULTS
Twenty-six were non-seminomatous tumors and only one was a seminoma. Based on the International Germ Cell Consensus Classification, two cases were classified as good prognosis, seven as intermediate prognosis and 18 as poor prognosis. Chemotherapy was carried out in all patients. Additionally, whole-brain radiotherapy was performed in 10 cases, stereotactic radiosurgery in six, whole-brain radiotherapy combined with stereotactic radiosurgery in three and complete surgical resection in five. Three patients received chemotherapy only. Cancer-specific 5- and 10-year survival rates were both 35.9%. The prognosis of those with brain metastases at the time of diagnosis tended to be better than those developing brain metastases during treatment. Those with a single brain metastasis showed significantly better survival than those with multiple brain metastases. No other significant prognostic factor was found at multivariate analysis.


CONCLUSIONS
Testicular germ cell tumors with brain metastases can be managed with the combination of whole-brain radiotherapy, stereotactic radiotherapy, and/or surgical resection in combination with chemotherapy.
Department of Urology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. nono@uro.med.osaka-u.ac.jp
Norio
N
Nonomura
Akira
A
Nagahara
Daizo
D
Oka
Masatoshi
M
Mukai
Yasutomo
Y
Nakai
Masashi
M
Nakayama
Kazuo
K
Nishimura
Kennichi
K
Kakimoto
Terukazu
T
Nakamura
Michiyuki
M
Usami
Akihiko
A
Okuyama
Tsuneharu
T
Miki
D000328:Adult; D001932:Brain Neoplasms / Q000556:secondary*; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000556:secondary*; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000473:pathology*; D055815:Young Adult