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. 2016 Feb 1;34(4):345-51.
doi: 10.1200/JCO.2015.62.7000. Epub 2015 Oct 12.

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

Darren R Feldman  1 , Anja Lorch  1 , Andrew Kramar  1 , Costantine Albany  1 , Lawrence H Einhorn  1 , Patrizia Giannatempo  1 , Andrea Necchi  1 , Aude Flechon  1 , Helen Boyle  1 , Peter Chung  1 , Robert A Huddart  1 , Carsten Bokemeyer  1 , Alexey Tryakin  1 , Teodoro Sava  1 , Eric William Winquist  1 , Ugo De Giorgi  1 , Jorge Aparicio  1 , Christopher J Sweeney  1 , Gabriella Cohn Cedermark  1 , Jörg Beyer  2 , Thomas Powles  1
Affiliations

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

Darren R Feldman et al. J Clin Oncol. .

Abstract

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: BM were present at initial diagnosis in 228 men (group A) and at relapse in 295 men (group B). OS at 3 years (3-year OS) was superior in group A versus group B (48% v 27%; P < .001). Multiple BM and the presence of liver or bone metastasis were independent adverse prognostic factors in both groups; primary mediastinal nonseminoma (group A) and elevations of α-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-year OS ranged from 0% to 70% in group A and from 6% to 52% 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 = .001).

Conclusion: Men with BM from GCT have poor OS, particularly if additional risk factors are present. High-dose chemotherapy and multimodality treatment seemed to improve survival probabilities in men with BM at relapse.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest are found in the article online at www.jco.org. Author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
(A) Progression-free survival in patients with brain metastases at initial diagnosis (group A) and at relapse (group B). (B) Overall survival in patients with brain metastases at initial diagnosis (group A) and at relapse (group B).
Fig 2.
Fig 2.
(A) Overall survival (OS) according to prognosis in patients with synchronous metastases at initial diagnosis (group A). (B) OS according to prognosis in patients with metachronous metastases at relapse (group B).
Fig 3.
Fig 3.
Results of multivariable analysis of treatments in patients with metachronous brain metastases at relapse (group B): (A) multimodality versus single-modality treatment and (B) high-dose versus conventional-dose chemotherapy. HR, hazard ratio.
Fig A1.
Fig A1.
(A) Hazard rate for progression in patients with brain metastases at initial diagnosis (group A) and at relapse (group B). (B) Hazard rate for death in patients with brain metastases at initial diagnosis (group A) and at relapse (group B).
Fig A2.
Fig A2.
Multivariable results of multimodality treatment in patients with synchronous brain metastases at initial diagnosis (group A). HR, hazard ratio.
See this image and copyright information in PMC

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