How would you manage asymptomatic brain metastases from testicular non-seminomatous germ cell tumor with a choriocarcinomatous component?

Despite the obvious issue of the blood brain barrier, BEP chemo alone (or VIP) is sufficient for treating such patients. We would, however, repeat head MRI just before starting second course of cisplatin combination chemotherapy to ensure appropriate response.

Despite the overall excellent outcomes for patients with germ cell tumors (GCT), patients with brain metastases are in the poor risk category in which the outcome is still unfavorable with more than 30% of patients succumbing to their disease.¹ Management of brain metastases is further complicated b...