title: Brain metastases associated with germ cell tumors may be treated with chemotherapy alone.
abstract: BACKGROUND
  The management of brain metastases in patients with germ cell tumors remains controversial. The authors assessed the outcome in this patient group after the introduction of GAMEC chemotherapy (14-day cisplatin, high-dose methotrexate, etoposide, and actinomycin-D with filgrastim support) and cessation of the routine use of cranial irradiation.
  
  
  METHODS
  Data were recorded prospectively from 39 patients with germ cell tumors and concurrent brain metastases who received treatment before and after the advent of GAMEC after they relapsed on conventional cisplatin-based chemotherapy. Neurosurgery was offered to selected patients. Radiotherapy generally was used only as a salvage therapy after chemotherapy failure. The primary outcome measure was overall survival and was depicted using a Kaplan-Meier plot.
  
  
  RESULTS
  The 3-year overall survival rates were 38% for the whole cohort, 69% for those who presented with brain metastases at diagnosis (group 1), and 21% and 0% for those who developed metastases after initial chemotherapy (group 2) and while receiving chemotherapy (group 3), respectively. For the whole cohort, the median overall survival was 10.6 months (range, 5.5 months to not evaluable); and, for groups 1, 2, and 3 individually, the overall survival was not yet reached (range, from 7.4 months to not evaluable), 6.2 months (range, 2.1-15.3 months), and 2.7 months (range, from 0.6 months to not evaluable), respectively. The 3-year survival rate for those who received GAMEC chemotherapy was 56% compared with 27% for those who received chemotherapy pre-GAMEC.
  
  
  CONCLUSIONS
  The prognosis for patients with germ cell tumors and brain metastases seems less bleak than previously thought. It is possible to achieve long-term survival with chemotherapy alone.
authors.affiliation: The Barts Cancer Center, St. Bartholomew's Hospital, Gloucester House, West Smithfield, London, United Kingdom.
authors.forename: Anna
authors.initials: A
authors.lastname: Hardt
authors.forename: Jonathan
authors.initials: J
authors.lastname: Krell
authors.forename: Peter D
authors.initials: PD
authors.lastname: Wilson
authors.forename: Victoria
authors.initials: V
authors.lastname: Harding
authors.forename: Simon
authors.initials: S
authors.lastname: Chowdhury
authors.forename: Danish
authors.initials: D
authors.lastname: Mazhar
authors.forename: Dan
authors.initials: D
authors.lastname: Berney
authors.forename: Justin
authors.initials: J
authors.lastname: Stebbing
authors.forename: Jonathan
authors.initials: J
authors.lastname: Shamash
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D011446:Prospective Studies
keywords: GAMEC; brain; germ cell tumors; high-dose; metastases; methotrexate