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Gamma knife radiosurgery in brain metastases from testicular tumors
1Department of Neurosurgery, University Hospital, Piazzale Stefani 1, 37126 Verona, Italy. antonio.nicolato@azosp.vr.it
Abstract:
To our knowledge, there are no published reports on the effectiveness of radiosurgery in the management of brain metastases from testicular nonseminomatous germ cell tumor. The authors evaluate the results of gamma knife (GK) treatment in three patients with these unusual intracranial lesions. Between April 1995 and July 2001, three patients with brain metastasis from testicular nonseminomatous germ cell tumor underwent adjuvant radiosurgery at our department. The primary tumor had been surgically removed in all cases. At diagnosis, one patient was stage IB and two were stage III poor risk. Chemotherapy and whole brain radiotherapy were administered before radiosurgery in all cases. Pre-GK radiotherapy was administered with a daily fraction dosage of 1.8-2.0 Gy. The indications for radiosurgery were tumor volume <20 cm3, microsurgery too risky, refusal of surgery. All the lesions were located in eloquent brain areas. Post-GK high-dose chemotherapy with autologous peripheral-blood stem-cell rescue was administered in two cases due to systemic recurrence of the disease. All patients are still alive with a median and mean follow-up period after radiosurgery of 63 and 68.3 mo, respectively. They had no neurological deficits at the latest examination. Neuroradiological follow-up invariably showed tumor growth control (complete response in two cases and partial response in one) with typically delayed post-radiosurgical imaging changes (transient in two cases and long-lasting in one). In conclusion, GK seems to be highly effective and safe in brain metastases from testicular nonseminomatous germ cell tumor. In cases with diffuse metastatic brain involvement, the whole brain radiotherapy preceding radiosurgery should be delivered with 1.8 Gy daily fraction to prevent the risk of long-lasting post-radiosurgical imaging changes.
Insights
Gamma Knife (GK) radiosurgery shows high effectiveness and safety for brain metastases from testicular nonseminomatous germ cell tumors. This treatment offers tumor control with no neurological deficits in patients with these rare intracranial lesions.
Area of Science:
- Oncology
- Neurosurgery
- Radiation Oncology
Background:
- Brain metastases from testicular nonseminomatous germ cell tumors are rare, with limited published data on management effectiveness.
- This study evaluates Gamma Knife (GK) radiosurgery for these unusual intracranial lesions.
Observation:
- Three patients with brain metastases from testicular nonseminomatous germ cell tumors received adjuvant GK radiosurgery between 1995 and 2001.
- All patients had undergone primary tumor removal and received chemotherapy and whole brain radiotherapy prior to GK treatment.
- Indications for GK included small tumor volume (<20 cm3), high surgical risk, or patient refusal of surgery, with lesions located in eloquent brain areas.
Findings:
- All three patients remained alive with a median follow-up of 63 months post-GK, exhibiting no neurological deficits.
- Neuroradiological follow-up demonstrated tumor growth control (two complete, one partial response).
- Delayed, typically transient, post-radiosurgical imaging changes were observed.
Implications:
- Gamma Knife radiosurgery appears to be a highly effective and safe treatment modality for brain metastases originating from testicular nonseminomatous germ cell tumors.
- For diffuse brain involvement, a specific whole brain radiotherapy fractionation (1.8 Gy daily) may help prevent long-lasting post-radiosurgical imaging changes.
