Abstract
Purpose
Little data exist on characteristics, treatment, and outcome of patients with bone metastases from germ cell cancer.
Methods
A total of 434 patients with poor prognosis germ cell cancer, who underwent primary high-dose chemotherapy (HD-CTX) within two phase II trials, were retrospectively analyzed.
Results
40 patients (9%) presented with primary bone metastases. Bone metastases were significantly more frequently observed in patients with primary mediastinal tumors, yolk sac tumor histology, and synchronous liver metastases. Overall response rate to HD-CTX was 85%. 20% of patients underwent consolidating radiotherapy, and 10% had resection of bone metastases revealing necrosis in all cases. Progression-free survival rate after primary treatment was 63% and, including salvage treatment after first relapse, overall long-term survival rate was 75%.
Four patients (0.9%) relapsed with isolated bone metastases, all with bone metastases at primary diagnosis. None had previously received surgery or radiotherapy and all died within 1 year. 10 patients with primary bone metastases showed recurrences at other localizations. No patient relapsed with bone plus other metastases or with de novo bone metastases.
Conclusions
Bone metastases were associated with a primary mediastinal nonseminoma, yolk sac histology, and liver metastases at first diagnosis. In this cohort of patients receiving HD-CTX as first-line treatment, 63% achieved long-term progression-free survival. Skeletal relapses were rare, but showed dismal outcome.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aldejmah A, Soulières D, Saad F (2007) Isolated solitary bony metastasis of a nonseminomatous germ cell tumor. Can J Urol 14:3458–3460
Arnold PM, Morgan CJ, Morantz RA, Eckard DA, Kepes JJ (2000) Metastatic testicular cancer presenting as spinal cord compression: report of two cases. Surg Neurol 54:27–33
Asthana AK, Singh OP, Pant GC, Agrawal MS (1988) Seminoma of testis with unusual bone metastasis. Br J Urol 62:380–381
Benedetti G, Rastelli F, Fedele M, Castellucci P, Damiani S, Crinò L (2006) Presentation of nonseminomatous germ cell tumor of the testis with symptomatic solitary bone metastasis. A case report with review of the literature. Tumori 92:433–436
Berglund RK, Lyden SP, Tsai EC, Lieberman I, Klein EA (2006) Nonseminomatous germ cell tumor after chemotherapy with residual mass invading the spine. Eur Urol 50:372–374
Bokemeyer C, Kollmannsberger C, Meisner C, Harstrick A, Beyer J, Metzner B, Hartmann JT, Schmoll HJ, Einhorn L, Kanz L, Nichols C (1999) First-line high-dose chemotherapy compared with standard-dose PEB/VIP chemotherapy in patients with advanced germ cell tumors: a multivariate and matched-pair analysis. J Clin Oncol 17:3450–3456
Bokemeyer C, Schleucher N, Metzner B, Thomas M, Rick O, Schmoll HJ, Kollmannsberger C, Boehlke I, Kanz L, Hartmann JT (2003) First-line sequential high-dose VIP chemotherapy with autologous transplantation for patients with primary mediastinal nonseminomatous germ cell tumours: a prospective trial. Br J Cancer 89:29–35
Bosco P, Bihrle W III, Malone MJ, Silverman ML (1994) Primary skeletal metastasis of a nonseminomatous germ cell tumor. Urology 43:564–566
Collis CH, Eckert H (1985) Seminoma of the testis with bone involvement: a report of three cases. Clin Radiol 36:467–468
Einhorn LH (2002) Curing metastatic testicular cancer. In: Proceedings of the National Academy of Sciences of the United States of America 99:4592–4595
Fléchon A, Culine S, Théodore C, Droz JP (2005) Pattern of relapse after first line treatment of advanced stage germ-cell tumors. Eur Urol 48:957–963
Hartmann JT, Gauler T, Metzner B, Gerl A, Casper J, Rick O, Horger M, Schleicher J, Derigs G, Mayer-Steinacker R, Beyer J, Kuczyk MA, Bokemeyer C, German Testicular Cancer Study Group (2007) Phase I/II study of sequential dose-intensified ifosfamide, cisplatin, and etoposide plus paclitaxel as induction chemotherapy for poor prognosis germ cell tumors by the German Testicular Cancer Study Group. J Clin Oncol 25:5742–5747
Hitchins RN, Philip PA, Wignall B, Newlands ES, Begent RHJ, Bagshawe R, Bagshawe KD (1988) Bone disease in testicular and extragonadal germ cell tumours. Br J Cancer 58:793–796
International germ cell consensus classification (1997) A prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group. J Clin Oncol 15:594–603
Kaplan E, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481
Motzer RJ, Nichols CJ, Margolin KA, Bacik J, Richardson PG, Vogelzang NJ, Bajorin DF, Lara PN Jr, Einhorn L, Mazumdar M, Bosl GJ (2007) Phase III randomized trial of conventional-dose chemotherapy with or without high-dose chemotherapy and autologous hematopoietic stem-cell rescue as first-line treatment for patients with poor-prognosis metastatic germ cell tumors. J Clin Oncol 25:247–256
Ozan E, Oztekin O, Kozacioglu Z, Postaci H, Adibelli ZH (2009) Metastatic testicular germ cell tumor presenting with abdominal pain: CT and MRI findings. JBR-BTR 92:256–258
Schmoll HJ, Kollmannsberger C, Metzner B, Hartmann JT, Schleucher N, Schöffski P, Schleicher J, Rick O, Beyer J, Hossfeld D, Kanz L, Berdel WE, Andreesen R, Bokemeyer C, German Testicular Cancer Study Group (2003) Long-term results of first-line sequential high-dose etoposide, ifosfamide, and cisplatin chemotherapy plus autologous stem cell support for patients with advanced metastatic germ cell cancer: an extended phase I/II study of the German Testicular Cancer Study Group. J Clin Oncol 21:4083–4091
Spermon JR, Oyen WJG, Strijk SP, Hulsbergen-van de Kaa CA, Witjes JA (2004) Solitary skull recurrence from stage I seminomatous germ cell tumor of testis. Urology 64:377–379
Uygun K, Karagol H, Kocak Z, Cicin I, Yalcin O, Caloglu M, Simsek O, Harmandar FA (2006) Isolated bone metastasis in testicular germ cell tumors: a case report and review of the literature. Onkologie 29:93–95
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Oechsle, K., Bokemeyer, C., Kollmannsberger, C. et al. Bone metastases in germ cell tumor patients. J Cancer Res Clin Oncol 138, 947–952 (2012). https://doi.org/10.1007/s00432-012-1169-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-012-1169-3