SEMINOMA WITH ISOLATED CENTRAL-NERVOUS-SYSTEM RELAPSE, AND SALVAGE WITH CRANIOSPINAL IRRADIATION

We report a case of a patient with isolated central nervous system rel apse of classical seminoma, refractory to intrathecal and systemic che motherapy, but successfully salvaged with craniospinal axis irradiatio n. A 44-year-old man with bulky Stage II classic seminoma obtained com plete remission with four cycles of cisplatin etoposide combination ch emotherapy, but relapsed with lumbar vertebral metastases with epidura l spinal cord compression 5 months after completion of primary treatme nt. He underwent laminectomy, local radiotherapy, and salvage chemothe rapy. Two months later he developed cranial nerve palsies, and magneti c resonance imaging confirmed leptomeningeal disease. After brain radi otherapy, systemic and intrathecal chemotherapies were begun but tumor recurred around the cauda equina, producing paraparesis. The patient received salvage craniospinal irradiation, with resolution of parapare sis and cranial nerve palsies. Thirty months after completion of crani ospinal radiotherapy, he remains in complete remission. We suggest con sideration of craniospinal axis irradiation as salvage therapy in pati ents with isolated central nervous system relapse of seminoma. (C) 199 8, Elsevier Science Inc. All rights reserved.