The management of brain metastases in germ cell tumors.

Twelve patients, with brain metastases from germ cell tumors were treated with combined whole brain irradiation and systemic chemotherapy. Two prognostic categories were identified. Patients with single brain metastases had a mean survival of 29.9 months, while patients with multiple brain lesions had a mean survival of 13.7 months. Four of the six patients with single brain lesions remain alive at 13, 14, 35 and 41 months following the clinical diagnosis of brain metastasis. The improved survival among patients with single lesions can be attributed to the sensitivity to chemotherapy of their tumors. Meningeal carcinomatosis, a previously unreported complication of metastatic germ cell tumor, developed in two patients who were initially treated for single brain metastasis. Both patients developed a clinical picture suggesting meningeal invasion by tumor and both had cytologic evidence in the cerebrospinal fluid of malignant cells.