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.
Cancer 49:12-18, 1982. ENTRAL NERVOUS SYSTEM METASTASES are a com-C mon occurrence in patients with disseminated germ cell tumors.' Twenty-one of 139 patients with disseminated germ cell tumors ( 15.1 %) reported by Williams and Einhorn developed clinical brain metastases.* Autopsy series from the Armed Forces Institute of Pathology and the Memorial Sloan-Kettering Cancer Center revealed incidences of brain metastases of 40% and 375'6, respectively, at postmortem e ~a m i n a t i o n . ~ Metastasis to the brain has generally represented a catastrophic occurrence heralding a poor prognosis. The mean survival after neurologic diagnosis of metastasis was 1.5 months in the report by Williams and Einhorn, with only one patient surviving 21 months. The Memorial Sloan-Kettering Hospital experience reported by Schold et al. was based on 47 patients with clinical brain metastases4
In the subpopulation of 24 patients who completed their course of radiation therapy the mean survival was three months, with no patients surviving more than I 2 months after the clinical diagnosis of brain metastases. We have adopted a new approach combining irradiation and chemotherapy in the management of brain metastases in patients with disseminated germ cell tumors. The experience with 12 patients receiving concurrent irradiation and chemotherapy for brain metastases is reviewed here.