Central Nervous System Metastases

DAVID I. QUINN, MBBS, PhD, FRACP OMID HAMID, MD OSCAR E. STREETER JR, MD THOMAS C. CHEN, MD

Central nervous system (CNS) metastases represent a relatively uncommon but difficult management issue in patients with testicular (and extracranial nongonadal) germ cell tumors. Their presentation varies from being an incidental finding on imaging studies at diagnosis or during the course of treatment to the catastrophic clinical consequences of acute raised intracranial pressure and/or cerebral hemorrhage. CNS metastases are an adverse prognostic and predictive factor in patients with germ cell tumors of both testicular and extragonadal origin. Despite this, early aggressive surgical and radiation therapy management of these metastases, in combination with systemic chemotherapy, can facilitate cure in 30 to 80% of patients. This chapter will describe the demographics, presentation, clinical outcome, and therapeutic management of patients with brain metastases from extracranial germ cell tumors. (Pineal germ cell tumors are discussed and illustrated in Chapter 21.)

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