Secundarismo encefálico de tumores germinales no seminomatosos : Revisión a propósito de cinco casos clínicos

Gloria Roldán; Robinson Rodríguez; Miguel  Musé

Authors

Gloria Roldán Ex Residente Servicio de Oncología Clínica. Hospital de Clínicas, Facultad de Medicina, Universidad de la República. Montevideo, Uruguay
Robinson Rodríguez Profesor Adjunto. Servicio de Oncología Clínica. Hospital de Clínicas, Facultad de Medicina, Universidad de la República. Montevideo, Uruguay
Miguel Musé Profesor Director. Servicio de Oncología Clínica, Hospital de Clínicas, Facultad de medicina, Universidad de la República. Montevideo, Uruguay

Keywords:

BRAIN NEOPLASMS, GERMINOMA, LUNG NEOPLASMS, TESTICULAR NEOPLASMS, COMBINED THERAPY, TREATMENT OUTCOME

Abstract

Patients with non seminomatous germinal tumors usually present encephalic metastasis in 8%-15% of the cases, generally in the context of a systemic fallen again. Although the first choice in these cases is surgery, its chemiosensitivity indicates initial chemotherapy followed by radiotherapy with or without surgery. As in patients with other solid tumors, carriers with multiple injuries receive systemic treatment with or without radiotherapy.

Five patients aged from 20 and 43 years with encephalic non-seminomatous germinal tumors are analysed: two patients presented encephalic secondarism during diagnosis and two other patients during injury progress. Respecting the remaining case, its diagnosis was established during an extraencephalic parcial responce. Coriocarcinoma and yolk sac tumors are the most frequent histologic variaties in this series. Four patients were at high risk, with extended lung commitment. Surgery was the first therapeutic manoeuvre in patients with secondarism. Benefits of systemic and radio combined treatment are highlighted in those who presented multiple encephalic injuries. Conclusions about survival could not be obtained due to the sample, but prognosis is not optimistic when encephalic secondarism is systemic treatment refractary.

References

1) Mahalati K, Bilen CY, Ozen H, Aki FH, Kendi S. The management of brain metastasis in nonseminomatous germ cell tumours. BJU Int 1999; 83(4): 457-61.
2) Yoshida S, Morii K. Brain metastasis from germinal tumors of the testis. Case report. J Neurosurg 1998; 88(4): 761-3.
3) Raina V, Singh SP, Kamble N, Tanwar R, Rao K, Dawar R, et al. Brain metastasis as the site of relapse in germ cell tumor of testis. Cancer 1993; 72(7): 2182-5.
4) Bredael JJ, Vugrin D, Whitmore WF Jr. Autopsy findings in 154 patients with germ cell tumors of the testis. Cancer 1982; 50(3): 548-51.
5) Cohn DA, Stuart-Harris R. Isolated central nervous system relapse of non-seminomatous germ cell tumour of the testis. A case report and review of the literature. Oncology 2001; 61(3): 184-8.
6) Feyerabend T, Wiedemann GJ, Steeves R. Advanced non-seminomatous germ cell cancer of the testis with brain metastases. Oncol Rep 2001; 8(2): 219-23.
7) Clemm C, Gerl A, Wndt TG, Pollinger B, Winkler PA, Wilmanns W. Current status of therapy of CNS metastases of germ cell tumors. Urologe A 1993; 32(3): 217-24.
8) Brin M, Droz JP, Caillaud JM, Bellet D, Amiel JL, Brule G. Cerebral metastases of malignant germinal tumors of the testis. J Urol 1982; 88(6): 345-7.
9) Maeda Y, Oyama H, Shishido T, Kin T, Izutani T, Yonese J, et al. Successful management for chemorefractory testicular cancer with brain and lung metastases. A case report. Nippon Hinyokika Gakkai Zasshi 1998; 89(12): 967-70.
10) Laguna M, Pizzocaro G, Klepp O, Algaba F, Kisbenedek L, Leiva O, et al. EAU guidelines on testicular cancer. Eur Urol 2001; 40: 102-10.
11) Fujita K, Tsujikawa K, Murosaki N, Sugao H, Itoh Y, Takao T, et al. A giant testicular tumor detected with dyspnea due to lung metastases: a case report. Hinyokika Kiyo 2001; 47(8): 599-604.
12) Soffietti R, Ruda R, Mutani R. Mangement of brain metastases. J Neurol 2002; 249: 1357-69.
13) Adler JR, Cox RS, Kaplan I, Martin DP. Stereotactic radiosurgical treatment of brain metastases. J Neurosurg 1992; 76: 444-9.
14) Auchter RM, Lamond JP, Alexander E, Buatti JM, Chappell R, Friedman WA, et al. A multi-institutional outcome and prognosis factor analysis of radiosurgery for resectable single brain metastasis. Int J Radiat Oncol Biol Phys 1996; 35: 27-35.
15) Brada M, Foord T. Radiosurgery for brain metastases. Clin Oncol (R Coll Radiol) 2002; 14: 28-30.
16) Rodríguez R. Impacto de la Técnica de Radiocirugía y Radiocirugía Estereotáxica Fraccionada mirado desde la Oncología Médica. Primera Jornada Nacional de Radiocirugía y Cirugía Estereotáxica Fraccionada. Salto, 2004.
17) Huang CF, Kondziolka D, Flickinger JC, Lunsford LD. Stereotactic radiosurgery for brainstem metastases. J Neurosurg 1999; 84: 563-8.
18) Li B, Yu J, Suntharalingam M, Kennedy AS, Amin PP, Chen Z, et al. Comparison of three treatment options for single brain metastasis from lung cancer. Int J Cancer 2000; 90: 37-45.
19) Gerl A, Clemm C, Kohl P, Schalhorn A, Wilmanns W. Central nervous system as sanctuary site of relapse in patients treated with chemotrherapy for metastatic testicualr cancer. Clin Exp Metastasis 1994; 12(3): 226-30.
20) Guenot M, Wager M, Bataille B, Irani J, Lapierre F. Cerebral metastases of testicular neoplasms. Apropos of 2 cases and review of the literature. Neurochirurgie 1994; 40(2): 135-7.