Brain metastases in patients with germ cell tumors: prognostic factors and treatment options - an analysis from the Global Germ Cell Cancer Group

Purpose: To define characteristics, treatment response, and outcomes of men with brain metastases (BM) from germ cell tumors (GCT). Patients and Methods: Data from 523 men with BM from GCT were collected retrospectively from 46 centers in 13 countries by using standardized questionnaires. Clinical features were correlated with overall survival (OS) as the primary end point. Results: BMwere present at initial diagnosis in 228 men (group A) and at relapse in 295 men (group B). OS at 3 years (3-yearOS) was superior in groupAversus groupB(48%v 27%;P,.001).MultipleBMand the presence of liver or bone metastasis were independent adverse prognostic factors in both groups; primary mediastinal nonseminoma (group A) and elevations of a-fetoprotein of 100 ng/mL or greater or of human chorionic gonadotropin of 5,000 U/L or greater (group B) were additional independent adverse prognostic factors. Depending on these factors, the 3-yearOS ranged from 0%to70%in groupAand from 6%to52%in group B. In group A, 99% of patients received chemotherapy; multimodality treatment or high-dose chemotherapy was not associated with statistically improved survival in multivariable analysis. In group B, only 54% of patients received chemotherapy; multimodality treatment was associated with improved survival compared with single-modality therapy (hazard ratio, 0.51; 95%CI, 0.36 to 0.73; P,.001), as was high-dose compared with conventional-dose chemotherapy (hazard ratio, 0.41; 95% CI, 0.24 to 0.70; P 5 .001).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 Winquist, Ugo De Giorgi, Jorge Aparicio, Christopher J. Sweeney, Gabriella Cohn Cedermark, Jörg Beyer and Thomas Powle