Advanced non-seminomatous germ cell cancer of the testis with brain metastases: Feasibility of additional brain irradiation and whole body hyperthermia plus chemotherapy

Patients with brain metastases in disseminated non-seminomatous germ cell c ancer of the testis are treated by combined modality, e.g., cisplatin-conta ining chemotherapy, whole brain irradiation and/or surgical excision. Howev er, cure rates of patients refractory to that standard treatment are low (5 -year survival rate <30%). Preclinical data on the use of hyperthermia comb ined with selected cytotoxic drugs clearly show increased tumor cell killin g compared to chemotherapy alone with no increase in toxicity to normal tis sue. These results are consistent with the concept that whole body hyperthe rmia (WBH) at 41.8<degrees>C is non-myelosuppressive and can potentiate the tumoricidal effects of specific chemotherapeutic agents, thus improving th e therapeutic index. We report on a patient with embryonal testicular cance r presenting with lung, liver and brain metastases who initially underwent orchiectomy, whole brain irradiation and cisplatin-containing chemotherapy. Restaging revealed minor regression of brain and lung metastases and no ch ange of liver metastases. However, B-HCG values dropped from initial 400000 mIU/ml to 12 mIU/ml with a normal alpha -fetoprotein all the time. Then, t wo cycles of whole body hyperthermia (WBH) plus chemotherapy were performed , followed by one cycle of chemotherapy without WBH. Radiotherapy, WBH and chemotherapy were well tolerated, especially no neurologic sequelae occurre d. After more than 5 years of follow-up, the patient is still alive and dis ease-free. WBH plus chemotherapy seems to be feasible and may contribute to long-term survival in patients with advanced stages of non-seminomatous ge rm cell cancer refractory to standard treatment.