BRAIN METASTASIS AS THE SITE OF RELAPSE IN GERM-CELL TUMOR OF TESTIS

Background. Brain metastases occur in approximately 8-15% of patients with testicular germ cell tumors and invariably are associated with re lapse at other sites, most commonly the lungs, or as a terminal event. Methods. The authors, from the Institute Rotary Cancer Hospital, a re gional cancer center in northern India, did a retrospective analysis t o determine how many previously treated patients had isolated cerebral metastasis develop. Results. Three of 123 patients with testicular ge rm cell tumor seen during a 6-year period starting in january 1986 had isolated cerebral metastasis develop during remission after initial t reatment. Two patients who had pure seminoma were treated with radiati on therapy and are alive and symptom free at 15 and 18 months. The thi rd patient had a combined tumor, the major component of which was embr yonal cell carcinoma, that required debulking surgery and radiation th erapy, and the patient died with recurrent cerebral metastases. Conclu sions. Review of the literature reveals that although cerebral metasta sis is well recognized in testicular cancer, particularly nonseminomat ous germ cell tumor (NSGCT), it is invariably preceded by systemic met astasis. Cerebral metastasis is extremely rare as the sole and present ing feature of relapse. This complication must be recognized and treat ment defined because it may become more frequent as patients survive f or longer periods with modern disease management.