Chemotherapy of disseminated germ cell tumors

The success of management of germ cell tumors puts an extraordinary burden on the physician and health care system to assure that cure is achieved in all patients except the small proportion that present with advanced refractory disease. New prognostic systems can define groups of patients who have excellent outcomes with treatment and a group of patients for whom treatment less reliably results in cure. Good risk disseminated disease should be treated with three cycles of bleomycin, etoposide, and cisplatin, whereas those with more advanced disease should receive four cycles. Postchemotherapy resection of residual disease is commonly required. In patients who recur after primary chemotherapy, salvage treatments can result in cure in 30% to 40% of patients.