Brain Metastases in Patients With Germ Cell Tumors: Prognostic Factors and Treatment Options—An Analysis From the Global Germ Cell Cancer Group

• DOI: 10.1200/jco.2015.62.7000
• Publication Date: 2015-10-13T20:08:14Z
• Authors: Darren R. Feldman; Anja Lorch; Andrew Kramar; Costantine Albany; Lawrence H. Einhorn; Patrizia Giannatempo; Andrea Necchi; Aude Flechon; Helen Boyle; Peter Chung; Robert A. Huddart; Carsten Bokemeyer; Alexey Tryakin; Teodoro Sava; Eric William Winq...; Ugo De Giorgi; Jorge Aparicio; Christopher J. Sw...; Gabriella Cohn Ce...; Jörg Beyer; Thomas Powles
• Keywords: Group B; Group A

Purpose To define characteristics, treatment response, and outcomes of men with brain metastases (BM) from germ cell tumors (GCT). Patients Methods Data 523 BM GCT were collected retrospectively 46 centers in 13 countries by using standardized questionnaires. Clinical features correlated overall survival (OS) as the primary end point. Results present at initial diagnosis 228 (group A) relapse 295 B). OS 3 years (3-year OS) was superior group A versus B (48% v 27%; P < .001). Multiple presence liver or bone metastasis independent adverse prognostic factors both groups; mediastinal nonseminoma elevations α-fetoprotein 100 ng/mL greater human chorionic gonadotropin 5,000 U/L B) additional factors. Depending on these factors, 3-year ranged 0% to 70% 6% 52% B. In A, 99% patients received chemotherapy; multimodality high-dose chemotherapy not associated statistically improved multivariable analysis. B, only 54% compared single-modality therapy (hazard ratio, 0.51; 95% CI, 0.36 0.73; .001), conventional-dose 0.41; 0.24 0.70; = Conclusion Men have poor OS, particularly if risk are present. High-dose seemed improve probabilities relapse.