TREATMENT OF CNS METASTASES IN GERM-CELL TUMORS

The incidence of CNS metastases in germ cell tumors is 2-5% and in ver y advanced disease over 20%. We report on 37 patients in whom CNS meta stases were diagnosed with the CAT scanner. Twenty-nine patients were subsequently treated. In 19 cases, treatment consisted of radiotherapy , 1 patient was only operated on, and in 9 cases patients received com bined surgery and radiotherapy. Two patients had seminomatous germ cel l tumors, 27 patients non-seminomatous tumors. HCG levels were high in 11 cases. In31 patients the disease was in the advanced stages; in 6 the disease was at the early stage. If there was just a solitary tumor , operation was the preferred mode of treatment. Radiotherapy consiste d of 50 GY whole-brain irradiation, with a tumor saturation up to 60 G Y. In 2 cases we suspected radiogenic necrosis. There were no other se vere side effects. Of the 37 patients, 4 obtained a long-term cure (ob servation time 34-90 months). Therapy must take all methods of treatme nt into consideration and should only be carried out in fully equipped medical centers. Only then can we hope to obtain long-term cures in i ndividuals with this usually fatal disease.