Onkológia 3/2023

CNS metastases in patients with testicular germ cell tumors

Germ cell tumors represent a model of curative malignancy with the introduction of the cisplatin-based chemotherapeutic combination in 1974, which can cure up to 80% of patients with disseminated GCTs. Approximately 10 to 15% of patients with advanced germ cell tumors develop brain metastases during their disease. Patients with brain metastases at the time of primary diagnosis of GCT (synchronous brain metastases) are classified as a poor prognostic group based on the IGCCCG classification. Patients who manifest with brain metastases at the time of relapse (metachronic brain metastases) after first-line treatment are generally also equally poorly predicted. Only patients with non-seminomatous GCTs (NSGCTs) are almost exclusively characterized by the presence of brain metastases. The overall survival of patients with synchronous metastases at the time of the primary diagnosis of GCT is approximately 50%, in contrast to patients with metastatic involvement of other extrapulmonary parenchymal organs initially, whose overall survival is better and around 80%. The optimal management of patients with GCTs with brain metastases remains controversial, as does the selection of the most appropriate therapeutic approach for a particular patient. The decision on the therapeutic procedure for a patient with brain metastases is based primarily on the institutional preferences of the center of expertise, which explains today›s wide variability in therapeutic modalities.

Keywords: germ cell tumors, relaps, CNS, metastatic disease