OUTCOMES OF BRAIN METASTASIS FROM NON-SEMINOMATOUS GERM CELL TUMOUR: A POPULATION-BASED REVIEW

Purpose:

To characterize the patients with brain metastases (BM) from non-seminomatous germ cell tumours (NSGCT) and describe their treatments and outcomes.

Materials and Methods:

A retrospective review of patients diagnosed with BM from NSGCT in British Columbia over 30 years was conducted using the provincial cancer registry. Demographic, clinical, disease characteristics, and treatment history were analyzed. Overall survival (OS) was assessed using the Kaplan-Meier method.

Results:

Preliminary registry review identified 260 NSGCT patients: eight (3%) had BM confirmed by imaging. The median follow-up was 10 months, with six deaths. The median OS from BM diagnosis was 2 months, and the 3-year OS was 25%. One patient had BM at presentation, while the rest had relapsed BM. All patients had symptomatic BM, with extremity weakness (6) being the most common. Four had a single BM, and four had multiple metastases. Two underwent surgical resection for mass effect. Seven received radiation therapy: four had whole brain radiation therapy (WBRT), two had volumetric modulated arc therapy (VMAT), and one had stereotactic radiotherapy (SRT). The most common chemotherapy regimen was ifosfamide, cisplatin, and etoposide. Three intracranial events occurred post-treatment and led to death: one intracranial failure after WBRT (41 Gy/24#), one leptomeningeal disease after SRT (35 Gy/5#), and one fatal intracranial hemorrhage after VMAT (50 Gy/25#). The remaining deaths were due to extracranial disease. Two long-term survivors (17 and 3 years) were less than 25 years old, had a single BM, excellent functional status, and received focused VMAT (54 Gy/30#) or WBRT (24 Gy/12#).

Conclusions:

BM from NSGCT is rare and associated with poor outcomes, though long-term survival is possible. Surgery, radiotherapy, and chemotherapy remain critical in management. Further registry review to identify potentially missing cases is planned.