[High-dose chemotherapy for advanced testicular germ cell tumors]

Since the introduction of cisplatin, the therapeutic outcome of patients with testicular germ cell tumors (TGCT) has markedly improved. Therefore, even advanced disease may be completely cured by an appropriate multidisciplinary therapy. However, approximately 20-30% of advanced TGCT patients could not be cured by induction therapy. In order to improve the prognosis for such poor-risk patients, several therapeutic modalities have been investigated, including high-dose chemotherapy (HDCT) combined with peripheral blood stem cell transplantation. The application of HDC to TGCT may be due to several reasons suchas younger age of TGCT patients, smoothrecovery from myelosuppression following chemotherapy and high sensitivity to chemotherapeutic agents. Although in a non-randomized study, the outcome of HDCT, particularly recurrence-free survival, seemed to be more favorable than that of conventional regimens, suchas bleomycine, etoposide and cisplatin and etoposide, ifosfamide and cisplatin, recently conducted randomized trials failed to demonstrate the usefulness of HDCT compared with the conventional regimen in both induction and salvage settings. Considering these findings in addition to the recent development of promising novel agents, it is reasonable to regard induction as well as salvage HDCTs as recommendation grade C in the guideline published by Japanese Urological Association.