Therapeutic dilemma of disseminated CNS germinoma and the potential of increased platinum-based chemotherapy delivery with osmotic blood-brain barrier disruption.

In contrast to disseminated extraneural germinoma, systemic chemotherapy in disseminated central nervous system germinoma often results in only transient responses. After surgery, cytoreduction was accomplished with systemic multiagent platinum-based chemotherapy in 4 consecutive patients known to have a poor prognosis, due to central nervous system germinoma at more than one anatomic site. When tumor enhancement resolved (i.e., blood-brain barrier integrity was restored), intensive consolidation therapy with carboplatin and etoposide was given in association with mannitol-induced osmotic blood-brain barrier disruption. Complete responses occurred in all 4 patients and currently 3 are tumor-free without radiotherapy 24-40 months from diagnosis, suggesting the importance of increased drug delivery for an extended period.