Journal of Clinical Oncology, Vol 15, 1449-1454, Copyright © 1997 by American Society of Clinical Oncology
Treatment of brain metastases in patients with testicular cancer
C Bokemeyer, P Nowak, A Haupt, B Metzner, H Kohne, JT Hartmann, L Kanz and HJ Schmoll
Department of Hematology/Oncology, Hannover University Medical School, Germany. carsten.bokemeyer@uuituebingeu.de
PURPOSE: Despite improved cure rates for patients with metastatic
testicular cancer with cisplatin-based combination chemotherapy, patients
who develop brain metastases are generally considered to possess a poor
prognosis. This report summarizes the long-term results in 44 patients with
brain metastases from testicular cancer treated between 1978 and 1995 at
Hannover University Medical School. PATIENTS AND METHODS: Histologically,
42 patients (95%) had a nonseminomatous germ cell cancer and two patients
(5%) a seminoma. Thirty-nine patients (89%) had lung metastases and 37
(84%) fulfilled the criteria for advanced disease according to the Indiana
University classification even without considering the brain metastases.
Eighteen patients (41%) presented with brain metastases at primary
diagnosis (group 1), four (9%) developed brain metastases at relapse after
a previous favorable response to combination chemotherapy (group 2), and 22
(50%) developed brain metastases during or directly after cisplatin-based
chemotherapy. Chemotherapy consisted of cisplatin-based combination
treatment and radiotherapy was given as whole-brain irradiation of 30 to 40
Gy and in single cases combined with a boost of 10 Gy to single lesions.
RESULTS: Overall, 10 patients achieved long-term survival (23%; 95%
confidence interval [CI], 10.1% to 35.4%). The prognosis was significantly
better for patients in groups 1 and 2, with six of 18 (33%) and three of
four (75%) patients alive, compared with only one of 22 (5%) in group 3 (P
< .01). Patients treated with either chemotherapy or radiotherapy alone
did not achieve long-term survival, while nine of 28 (32%) who received
treatment with both modalities with or without surgery achieved sustained
long-term survival. During univariate analysis, patients with the diagnosis
of brain metastases at first presentation (P < .01), patients with a
single brain lesion (P < .02), and patients who received combined
chemotherapy and radiotherapy (P < .03) had a significantly improved
outcome. CONCLUSIONS: Long-term survival can be achieved in approximately
25% of patients with brain metastases from testicular cancer by combined
treatment with brain irradiation and aggressive cisplatin-based
chemotherapy. Patients who develop brain metastases during systemic
treatment should receive only palliative radiation therapy, since sustained
survival will not be reached.
