{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:21:10Z","timestamp":1791231670546,"version":"4.1.0"},"reference-count":13,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"4","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2016,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To define characteristics, treatment response, and outcomes of men with brain metastases (BM) from germ cell tumors (GCT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>Data from 523 men with BM from GCT were collected retrospectively from 46 centers in 13 countries by using standardized questionnaires. Clinical features were correlated with overall survival (OS) as the primary end point.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>BM were present at initial diagnosis in 228 men (group A) and at relapse in 295 men (group B). OS at 3 years (3-year OS) was superior in group A versus group B (48% v 27%; P &lt; .001). Multiple BM and the presence of liver or bone metastasis were independent adverse prognostic factors in both groups; primary mediastinal nonseminoma (group A) and elevations of \u03b1-fetoprotein of 100 ng\/mL or greater or of human chorionic gonadotropin of 5,000 U\/L or greater (group B) were additional independent adverse prognostic factors. Depending on these factors, the 3-year OS ranged from 0% to 70% in group A and from 6% to 52% in group B. In group A, 99% of patients received chemotherapy; multimodality treatment or high-dose chemotherapy was not associated with statistically improved survival in multivariable analysis. In group B, only 54% of patients received chemotherapy; multimodality treatment was associated with improved survival compared with single-modality therapy (hazard ratio, 0.51; 95% CI, 0.36 to 0.73; P &lt; .001), as was high-dose compared with conventional-dose chemotherapy (hazard ratio, 0.41; 95% CI, 0.24 to 0.70; P = .001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Men with BM from GCT have poor OS, particularly if additional risk factors are present. High-dose chemotherapy and multimodality treatment seemed to improve survival probabilities in men with BM at relapse.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/jco.2015.62.7000","type":"journal-article","created":{"date-parts":[[2015,10,13]],"date-time":"2015-10-13T16:08:14Z","timestamp":1444752494000},"page":"345-351","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":87,"title":["Brain Metastases in Patients With Germ Cell Tumors: Prognostic Factors and Treatment Options\u2014An Analysis From the Global Germ Cell Cancer Group"],"prefix":"10.1200","volume":"34","author":[{"given":"Darren R.","family":"Feldman","sequence":"first","affiliation":[{"name":"Darren R. Feldman, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Anja Lorch, University Hospital D\u00fcsseldorf, D\u00fcsseldorf; Carsten Bokemeyer, University Hospital Eppendorf, Hamburg, Germany; Andrew Kramar, Centre Oscar Lambret, Lille; Aude Flechon and Helen Boyle, Centre L\u00e9on B\u00e9rard, Lyon, France; Costantine Albany and Lawrence H. Einhorn, Indiana University, Bloomington, IN; Patrizia Giannatempo and Andrea Necchi, Fondazione Istituto di Ricovero e..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Lorch","sequence":"additional","affiliation":[{"name":"Darren R. Feldman, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Anja Lorch, University Hospital D\u00fcsseldorf, D\u00fcsseldorf; Carsten Bokemeyer, University Hospital Eppendorf, Hamburg, Germany; Andrew Kramar, Centre Oscar Lambret, Lille; Aude Flechon and Helen Boyle, Centre L\u00e9on B\u00e9rard, Lyon, France; Costantine Albany and Lawrence H. Einhorn, Indiana University, Bloomington, IN; Patrizia Giannatempo and Andrea Necchi, Fondazione Istituto di Ricovero e..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Kramar","sequence":"additional","affiliation":[{"name":"Darren R. Feldman, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Anja Lorch, University Hospital D\u00fcsseldorf, D\u00fcsseldorf; Carsten Bokemeyer, University Hospital Eppendorf, Hamburg, Germany; Andrew Kramar, Centre Oscar Lambret, Lille; Aude Flechon and Helen Boyle, Centre L\u00e9on B\u00e9rard, Lyon, France; Costantine Albany and Lawrence H. Einhorn, Indiana University, Bloomington, IN; Patrizia Giannatempo and Andrea Necchi, Fondazione Istituto di Ricovero e..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Costantine","family":"Albany","sequence":"additional","affiliation":[{"name":"Darren R. Feldman, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Anja Lorch, University Hospital D\u00fcsseldorf, D\u00fcsseldorf; Carsten Bokemeyer, University Hospital Eppendorf, Hamburg, Germany; Andrew Kramar, Centre Oscar Lambret, Lille; Aude Flechon and Helen Boyle, Centre L\u00e9on B\u00e9rard, Lyon, France; Costantine Albany and Lawrence H. Einhorn, Indiana University, Bloomington, IN; Patrizia Giannatempo and Andrea Necchi, Fondazione Istituto di Ricovero e..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence H.","family":"Einhorn","sequence":"additional","affiliation":[{"name":"Darren R. Feldman, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Anja Lorch, University Hospital D\u00fcsseldorf, D\u00fcsseldorf; Carsten Bokemeyer, University Hospital Eppendorf, Hamburg, Germany; Andrew Kramar, Centre Oscar Lambret, Lille; Aude Flechon and Helen Boyle, Centre L\u00e9on B\u00e9rard, Lyon, France; Costantine Albany and Lawrence H. Einhorn, Indiana University, Bloomington, IN; Patrizia Giannatempo and Andrea Necchi, Fondazione Istituto di Ricovero e..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizia","family":"Giannatempo","sequence":"additional","affiliation":[{"name":"Darren R. Feldman, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Anja Lorch, University Hospital D\u00fcsseldorf, D\u00fcsseldorf; Carsten Bokemeyer, University Hospital Eppendorf, Hamburg, Germany; Andrew Kramar, Centre Oscar Lambret, Lille; Aude Flechon and Helen Boyle, Centre L\u00e9on B\u00e9rard, Lyon, France; Costantine Albany and Lawrence H. Einhorn, Indiana University, Bloomington, IN; Patrizia Giannatempo and Andrea Necchi, Fondazione Istituto di Ricovero e..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Necchi","sequence":"additional","affiliation":[{"name":"Darren R. Feldman, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Anja Lorch, University Hospital D\u00fcsseldorf, D\u00fcsseldorf; Carsten Bokemeyer, University Hospital Eppendorf, Hamburg, Germany; Andrew Kramar, Centre Oscar Lambret, Lille; Aude Flechon and Helen Boyle, Centre L\u00e9on B\u00e9rard, Lyon, France; Costantine Albany and Lawrence H. Einhorn, Indiana University, Bloomington, IN; Patrizia Giannatempo and Andrea Necchi, Fondazione Istituto di Ricovero e..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aude","family":"Flechon","sequence":"additional","affiliation":[{"name":"Darren R. Feldman, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Anja Lorch, University Hospital D\u00fcsseldorf, D\u00fcsseldorf; Carsten Bokemeyer, University Hospital Eppendorf, Hamburg, Germany; Andrew Kramar, Centre Oscar Lambret, Lille; Aude Flechon and Helen Boyle, Centre L\u00e9on B\u00e9rard, Lyon, France; Costantine Albany and Lawrence H. Einhorn, Indiana University, Bloomington, IN; Patrizia Giannatempo and Andrea Necchi, Fondazione Istituto di Ricovero e..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Boyle","sequence":"additional","affiliation":[{"name":"Darren R. Feldman, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Anja Lorch, University Hospital D\u00fcsseldorf, D\u00fcsseldorf; Carsten Bokemeyer, University Hospital Eppendorf, Hamburg, Germany; Andrew Kramar, Centre Oscar Lambret, Lille; Aude Flechon and Helen Boyle, Centre L\u00e9on B\u00e9rard, Lyon, France; Costantine Albany and Lawrence H. Einhorn, Indiana University, Bloomington, IN; Patrizia Giannatempo and Andrea Necchi, Fondazione Istituto di Ricovero e..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Chung","sequence":"additional","affiliation":[{"name":"Darren R. Feldman, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Anja Lorch, University Hospital D\u00fcsseldorf, D\u00fcsseldorf; Carsten Bokemeyer, University Hospital Eppendorf, Hamburg, Germany; Andrew Kramar, Centre Oscar Lambret, Lille; Aude Flechon and Helen Boyle, Centre L\u00e9on B\u00e9rard, Lyon, France; Costantine Albany and Lawrence H. Einhorn, Indiana University, Bloomington, IN; Patrizia Giannatempo and Andrea Necchi, Fondazione Istituto di Ricovero e..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Huddart","sequence":"additional","affiliation":[{"name":"Darren R. 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Feldman, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Anja Lorch, University Hospital D\u00fcsseldorf, D\u00fcsseldorf; Carsten Bokemeyer, University Hospital Eppendorf, Hamburg, Germany; Andrew Kramar, Centre Oscar Lambret, Lille; Aude Flechon and Helen Boyle, Centre L\u00e9on B\u00e9rard, Lyon, France; Costantine Albany and Lawrence H. Einhorn, Indiana University, Bloomington, IN; Patrizia Giannatempo and Andrea Necchi, Fondazione Istituto di Ricovero e..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexey","family":"Tryakin","sequence":"additional","affiliation":[{"name":"Darren R. Feldman, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Anja Lorch, University Hospital D\u00fcsseldorf, D\u00fcsseldorf; Carsten Bokemeyer, University Hospital Eppendorf, Hamburg, Germany; Andrew Kramar, Centre Oscar Lambret, Lille; Aude Flechon and Helen Boyle, Centre L\u00e9on B\u00e9rard, Lyon, France; Costantine Albany and Lawrence H. Einhorn, Indiana University, Bloomington, IN; Patrizia Giannatempo and Andrea Necchi, Fondazione Istituto di Ricovero e..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodoro","family":"Sava","sequence":"additional","affiliation":[{"name":"Darren R. Feldman, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Anja Lorch, University Hospital D\u00fcsseldorf, D\u00fcsseldorf; Carsten Bokemeyer, University Hospital Eppendorf, Hamburg, Germany; Andrew Kramar, Centre Oscar Lambret, Lille; Aude Flechon and Helen Boyle, Centre L\u00e9on B\u00e9rard, Lyon, France; Costantine Albany and Lawrence H. Einhorn, Indiana University, Bloomington, IN; Patrizia Giannatempo and Andrea Necchi, Fondazione Istituto di Ricovero e..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric William","family":"Winquist","sequence":"additional","affiliation":[{"name":"Darren R. Feldman, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Anja Lorch, University Hospital D\u00fcsseldorf, D\u00fcsseldorf; Carsten Bokemeyer, University Hospital Eppendorf, Hamburg, Germany; Andrew Kramar, Centre Oscar Lambret, Lille; Aude Flechon and Helen Boyle, Centre L\u00e9on B\u00e9rard, Lyon, France; Costantine Albany and Lawrence H. Einhorn, Indiana University, Bloomington, IN; Patrizia Giannatempo and Andrea Necchi, Fondazione Istituto di Ricovero e..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugo","family":"De Giorgi","sequence":"additional","affiliation":[{"name":"Darren R. Feldman, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Anja Lorch, University Hospital D\u00fcsseldorf, D\u00fcsseldorf; Carsten Bokemeyer, University Hospital Eppendorf, Hamburg, Germany; Andrew Kramar, Centre Oscar Lambret, Lille; Aude Flechon and Helen Boyle, Centre L\u00e9on B\u00e9rard, Lyon, France; Costantine Albany and Lawrence H. Einhorn, Indiana University, Bloomington, IN; Patrizia Giannatempo and Andrea Necchi, Fondazione Istituto di Ricovero e..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Aparicio","sequence":"additional","affiliation":[{"name":"Darren R. Feldman, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY; Anja Lorch, University Hospital D\u00fcsseldorf, D\u00fcsseldorf; Carsten Bokemeyer, University Hospital Eppendorf, Hamburg, Germany; Andrew Kramar, Centre Oscar Lambret, Lille; Aude Flechon and Helen Boyle, Centre L\u00e9on B\u00e9rard, Lyon, France; Costantine Albany and Lawrence H. Einhorn, Indiana University, Bloomington, IN; Patrizia Giannatempo and Andrea Necchi, Fondazione Istituto di Ricovero e..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Sweeney","sequence":"additional","affiliation":[{"name":"Darren R. 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