THERAPEUTIC DILEMMA OF DISSEMINATED CNS GERMINOMA AND THE POTENTIAL OF INCREASED PLATINUM-BASED CHEMOTHERAPY DELIVERY WITH OSMOTIC BLOOD-BRAIN-BARRIER DISRUPTION

In contrast to disseminated extraneural germinoma, systemic chemothera py in disseminated central nervous system germinoma often results in o nly transient responses. After surgery, cytoreduction was accomplished with systemic multiagent platinum-based chemotherapy in 4 consecutive patients known to have a poor prognosis, due to central nervous syste m germinoma at more than one anatomic site. When tumor enhancement res olved (i.e., blood-brain barrier integrity was restored), intensive co nsolidation therapy with carboplatin and etoposide was given in associ ation with mannitol-induced osmotic blood-brain barrier disruption. Co mplete responses occurred in all 4 patients and currently 3 are tumor- free without radiotherapy 24-40 months from diagnosis, suggesting the importance of increased drug delivery for an extended period.