Synchronous versus metachronous brain metastasis from testicular germ cell tumors (TGCT): an analysis from the Spanish Germ Cell Cancer Group data base
Thirty-three out of 6,200 cases (0.5 %). Nineteen patients (57 %) group 1 synchronous, 13 (40 %) group 2 metachronous and only one developed brainmetastasis during cisplatin-based chemotherapy (excluded from the analysis). Median serum BHCG levels at initial diagnosis was higher in group 1, whereas elevated AFP serum levels were more common in group 2. Histology in the primary tumor chorionic carcinoma for group 1 versus embryonal carcinoma for group 2. Mainly solitary brainmetastasis in group 2 (54 versus 21 %, respectively). The median overall survival from the diagnosis of central nervous system involvement was 16 months for group 1 (CI 95 % 13.9-18) and 23 months (95 % CI 0-165) for group 2 (log rank p = 0.84). Long-term survivors were practically identical in the two groups (38.9 % group 1 versus 38.5 % group 2). Regardless of the timing of brainmetastasis, those patients that achieved complete response to the treatment had better survival (log rank p 0.003).
CONCLUSION:
Although some distinctive clinical characteristics have been found between patients with synchronous versus metachronous brainmetastasis from TGCT, the timing of brainmetastasis did not seem to have prognostic influence, but due to the retrospective nature of the analysis and the results should be interpreted with caution (AU)