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 by the lack of a clear consensus on the optimal treatment approach for these patients, in part because brain metastases occur infrequently. Brain metastases more commonly occur in patients with nonseminomatous histology,² especially choriocarcinoma. Brain metastases at initial diagnosis are often associated with high serum beta-HCG levels and patients often have metastases at other sites (lung, liver and/or bone).² A large multi-institutional, ret...