Abstract
Isolated central nervous system relapse in patients treated successfully with cisplatin-based chemotherapy for testicular cancer has been described infrequently. In a retrospective analysis we identified this complication in six of 417 patients. Five of the six patients had advanced pulmonary dissemination at onset of chemotherapy, and post-chemotherapy surgery did not reveal viable tumour tissue in any of these cases. All six patients developed a single cerebral metastasis during complete remission a median four months after discontinuation of chemotherapy. Five patients were treated with surgery and subsequent radio-therapy, one patient with irradiation alone. Three patients are alive relapse-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 as a sanctuary site in chemotherapy-treated testicular cancer. A review of the literature shows that an isolated cerebral relapse is an extremely rare complication, but carries a relatively favourable prognosis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Einhorn LH and Donohue JP, 1977, Combination chemotherapy withcis-diamminedichloroplatinum, vinblastine, and bleomycin in disseminated testicular cancer.Ann Intern Med,87, 293–8.
Aass N, Klepp O, Cavallin-Stahl E,et al. 1991, Prognostic factors in unselected patients with non-seminomatous metastatic testicular cancer: a multi-center experience.J Clin Oncol,9, 818–26.
Mead GM, Stenning SP, Parkinson MC,et al. 1992, The Second Medical Research Council Study of prognostic factors in nonseminomatous germ cell tumors.J Clin Oncol,10, 85–94.
Gerl A, Clemm C, Lamerz R, Mann K and Wilmanns W, 1993, Prognostic implications of tumour marker analysis in non-seminomatous germ cell tumours with poor prognosis metastatic disease.Eur J Cancer,29A, 961–5.
Lester SG, Morphis II JG, Hornback NB, Williams SD and Einhorn LH, 1984, Brain metastases and testicular tumors: need for aggressive therapy.J Clin Oncol,2, 1397–403.
Spears WT, Morphis II JG, Lester SG, Williams SD and Einhorn LH, 1992, Brain metastases and testicular tumors: long-term survival.Int J Radiation Oncology Biol Phys,22, 17–22.
Clemm C, Gerl A, Wendt G,et al. 1993, Derzeitiger Stand der Therapie von ZNS-Metastasen bei Keimzelltumoren.Urologe[A],32, 217–24.
Logothetis CJ, Samuels ML and Trindade A, 1982, The management of brain metastases in germ cell tumors.Cancer,49, 12–18.
Clemm C, Hartenstein R, Willich N, Boening L and Wilmanns W, 1986, Vinblastine-ifosfamide-cisplatin treatment of bulky seminoma.Cancer,58, 2203–7.
Gerl A, Clemm C, Hentrich M, Hartenstein R and Wilmanns W, 1993, Etoposide, cisplatin, bleomycin, and cyclophosphamide (ECBC) as first-line chemotherapy for poor-risk non-seminomatous germ cell tumors.Acta Oncol,32, 541–6.
Bokemeyer C and Schmoll HJ, 1993, Treatment of advanced germ cell tumours by dose intensified chemotherapy with haematopoetic growth factors or peripheral blood stem cells (PBSC).Eur Urol,23, 223–30.
Schold SC, Vugrin D, Golbey RB and Posner JB, 1979, Central nervous system metastases from germ cell tumor of testis.Semin Oncol,6, 102–8.
Williams SD and Einhorn LH, 1979, Brain metastases in disseminated germinal neoplasms, incidence and clinical course.Cancer,44, 1514–16.
Raina V, Singh SP, Kamble N,et al. 1993, Brain metastasis as the site of relapse in germ cell tumor of testis.Cancer,72, 2182–5.
James PPB and Mead GM, 1992, Sanctuary site relapse in chemotherapy-treated testicular cancer.Ann Oncol,3, 41–3.
Raghavan D, Mackintosh JF, Fox RM,et al. 1987, Improved survival after brain metastases in non-seminomatous germ cell tumours with combined modality treatment.Br J Urol,60, 364–7.
Josefsen D, Ous S, Hoie J, Stenwig AE and Fossa SD, 1993, Salvage treatment in male patients with germ cell tumours.Br J Cancer,67, 568–72.
Rustin GJ, Newlands ES, Bagshawe KD, Begent RHJ and Crawford SM, 1986, Successful management of metastatic and primary germ cell tumors in the brain.Cancer,57, 2108–13.
Ginsberg S, Kirshner J, Reich S,et al. 1981, Systemic chemotherapy for a primary germ cell tumour of the brain: a pharmacokinetic study.Cancer Treat Rep,65, 477–83.
Stewart OJ, Richard M, Hugenholtz H and Dennerey J, 1983, VP-16 and VM-26 penetration into human brain tumors.Proc Am Assoc Cancer Res,24, 133.
Jelsma RK and Carroll M, 1989, Brain metastasis from nonseminomatous germ cell tumors of the testis: case report and review of the role of surgery.Neurosurgery,25, 814–19.
Patchell RA, Tibbs PA, Walsh JW,et al. 1990, A randomized trial of surgery in the treatment of single metastases to the brain.N Engl J Med,322, 494–500.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Gerl, A., Clemm, C., Kohl, P. et al. Central nervous system as sanctuary site of relapse in patients treated with chemotherapy for metastatic testicular cancer. Clin Exp Metast 12, 226–230 (1994). https://doi.org/10.1007/BF01753890
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01753890