Chemotherapy of disseminated germ cell tumors

The fact that germ cell tumors can be successfully managed puts an extraord inary burden on the physician and health care system to ensure that the pro mise of cure is achieved in all patients except the small proportion that p resent with advanced refractory disease. Good risk disseminated disease sho uld be treated with three cycles of bleomycin, etoposide and cisplatin (BEP ) whereas those with more advanced disease should receive four cycles. Post chemotherapy resection of residual disease is commonly required. In patient s in whom disease recurs after primary chemotherapy, salvage treatments can result in cure in 30-40% of patients. Physicians managing these patients s hould be aware of some of the pitfalls encountered when determining relapse and should be versed in the indications for salvage conventional dose chem otherapy, high dose chemotherapy, and the role of aggressive desperation su rgery.