[Treatment of germ cell tumors at the threshold of the third millennium]

The aim of the authors is to present the risk factors and the risk factors based treatment strategy of germ cell tumors. They review the risk adapted treatment strategy of germ cell tumors using the treatment policy of the Léon Bérard Oncological Center and the current findings published. More than of 80% germ cell tumors may be cured by standard treatment. The treatment of stage I seminoma is lumboaortic radiotherapy and that of stage I non seminoma is either surveillance, retroperitoneal lymph node dissection or chemotherapy depending on the risk factors of extratesticular involvement (pure embryonal carcinoma, vascular invasion). The treatment of metastatic cases is chemotherapy: three cycles of bleomycin, etoposid, cisplatin of four cycles of the similar components without bleomycin for good risk patients, and four cycles bleomycin, etoposid and cisplatin in poor risk cases. The overall five year survival rates are 90 and 50% in cases of good and poor prognosis groups respectively. The indication of retroperitoneal lymph node dissection depends on the size of retroperitoneal spreading prior to chemotherapy and on the efficacy of chemotherapy. The second line salvage treatment is four cycles of a combination of vinblastin, ifosfamide and cisplatin. After salvage chemotherapy the resection of all residual masses is recommended. New drugs, such as gemcitabine, taxotere, oxaliplatin and high dose chemotherapy may bring further success, however these new treatment modalities are not available for clinical practice in Hungary. Risk adapted treatment for germ cell tumors decreasing the early and late toxicity's of conventional treatment may improve the patients quality of life, and may decrease the cost of standard treatment in Hungary. The said new medication and the use of high dose chemotherapy may further improve the chances of patients with poor and intermediate prognosis and of those who are resistant to the cisplatin based standard therapy.