Synchronous versus metachronous brain metastasis from testicular germ cell tumors (TGCT): an analysis from the Spanish Germ Cell Cancer Group data base.
BACKGROUND
Brain metastases of testicular germ cell tumor (TGCT) are a rare event. Prognostic is poor and there is not much evidence on optimal management of these patients.


METHODS
A review of case records of germ cell tumor patients within the Spanish Germ Cell Cancer Group data base from 1994 to 2012 was conducted.


RESULTS
Thirty-three out of 6,200 cases (0.5 %). Nineteen patients (57 %) group 1: synchronous, 13 (40 %) group 2: metachronous and only one developed brain metastasis during cisplatin-based chemotherapy (excluded from the analysis). Median serum BHCG levels at initial diagnosis was higher in group 1, whereas elevated AFP serum levels were more common in group 2. Histology in the primary tumor: chorionic carcinoma for group 1 versus embryonal carcinoma for group 2. Mainly solitary brain metastasis in group 2 (54 versus 21 %, respectively). The median overall survival from the diagnosis of central nervous system involvement was 16 months for group 1 (CI 95 % 13.9-18) and 23 months (95 % CI 0-165) for group 2 (log rank p = 0.84). Long-term survivors were practically identical in the two groups (38.9 % group 1 versus 38.5 % group 2). Regardless of the timing of brain metastasis, those patients that achieved complete response to the treatment had better survival (log rank p 0.003).


CONCLUSIONS
Although some distinctive clinical characteristics have been found between patients with synchronous versus metachronous brain metastasis from TGCT, the timing of brain metastasis did not seem to have prognostic influence, but due to the retrospective nature of the analysis and the results should be interpreted with caution.
Hospital Lluis Alcanyis Xàtiva, Valencia, Spain, girones_reg@gva.es.
R
R
Girones
J
J
Aparicio
P
P
Roure
J R
JR
Germa-Lluch
X
X
García Del Muro
S
S
Vazquez-Estevez
A
A
Saenz
J
J
Sastre
J
J
Arranz Arija
E
E
Gallardo
E
E
Gonzalez-Billalabeitia
A
A
Sanchez-Hernandez
J
J
Terrasa
A
A
Hernandez
C
C
Santander
E
E
Cillan
N
N
Sagastibelza
D
D
Almenar-Cubells
M
M
Lopez Brea
J P
JP
Maroto
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000401:mortality / Q000556:secondary*; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D055815:Young Adult