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Year : 1996  |  Volume : 12  |  Issue : 1  |  Page : 12-17

Role of aggressive therapy in germ cell tumours of testes with brain metastases


Department of Uro-Oncology, Tata Memorial Hospital, Mumbai, India

Correspondence Address:
S M Desai
Department of Uro-Oncology, Tata Memorial Hospital, Mumbai
India
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Source of Support: None, Conflict of Interest: None


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From 1980 to 1990, 425 patients with germ cell tumours of testes were treated. 32 (7.5 percent) were identified to have brain metastases at some time during therapy. They were grouped into 3 groups. Group-I (n=10) presented with brain metastases at initial diagnosis, group-II (n-9) relapsed in brain after achieving a complete response to chemotherapy (CT) for systemic disease, and group-Ill (n-13) developed brain metastases as a part of ongoing progressive disease. The group-I patients were treated aggressively with CT and whole brain radiotherapy (WBRT). The group-II patients likewise were also treated aggressively with a combination of CT and WBRT, or craniotomy and excision if brain was the only site of relapse. The group-Ill patients were palliated with WBRT. In the final analysis though brain metastasis is considered as a poor prognostic feature, a subset of patients could be identified in whom curative intent aggressive therapy has yielded impressive median overall survival of 52 months (group-I) and 51 months (group-II) respectively. On a premise that brain does act as a sanctuary to first-line standard CT, we believe in consolidation WBRT in patients who present as brain metastases at initial diagnosis as well as those who relapse in brain along with peripheral relapses.


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