The impact of chemotherapy in germ cell tumours

It is widely appreciated that the application of chemotherapy in the treatment of germ cell tumours exemplifies the best results to be expected from this approach in solid tumours, since the majority of patients treated are now cured. Against a background of steadily rising incidence of testicular cancer, the impact of this highly effective treatment can be measured using national statistics, which for most countries in the developed world indicate a corresponding fall in mortality over the past 15 years. For some countries, however, no such improvement has taken place, presumably reflecting inadequate facilities in those countries for securing appropriate treatment, particularly cisplatin. In most specialist centres, current clinical studies are aimed at reducing the toxicity of treatment for the majority of patients cured of their disease. The other remaining challenge in management is to improve the results of treatment in the small minority of patients for whom chemotherapy is still not curative. More intensive schedules are being tested, and randomized trials to test these approaches are recommended.