CENTRAL-NERVOUS-SYSTEM AS SANCTUARY SITE OF RELAPSE IN PATIENTS TREATED WITH CHEMOTHERAPY FOR METASTATIC TESTICULAR CANCER

Isolated central nervous system relapse in patients treated successful ly with cisplatin-based chemotherapy for testicular cancer has been de scribed infrequently. In a retrospective analysis we identified this c omplication in six of 417 patients. Five of the six patients had advan ced pulmonary dissemination at onset of chemotherapy, and post-chemoth erapy surgery did not reveal viable tumour tissue in any of these case s. All six patients developed a single cerebral metastasis during comp lete remission a median four months after discontinuation of chemother apy. Five patients were treated with surgery and subsequent radiothera py, one patient with irradiation alone. Three patients are alive relap se-free 19, 62 and 86 months after diagnosis of cerebral relapse. One patient was alive with cerebral disease for 12 months without evidence of systemic recurrence. Our data demonstrate that the brain may act a s a sanctuary site in chemotherapy-treated testicular cancer. A review of the literature shows that an isolated cerebral relapse is an extre mely rare complication, but carries a relatively favourable prognosis.