Is there still indication of high-dose chemotherapy with hematopoietic stem-cell support in the treatment of germ-cell tumors?

Germ-cell tumor patients are cured in 80% of cases. Twenty per cent of pati ents had a relapse or an incomplete response after first line chemotherapy, and only one third of them are alive free of disease at long term. Differe nt approaches were performed to increase the results either in first line c hemotherapy of poor prognosis patients or in first salvage. High dose chemo therapy with stem-cell support is one of them. The drugs infused are etopos ide, carboplatin, cyclophosphamide and ifosfamide. Actually, no randomized performed trial showed the superiority of high dose chemotherapy in first l ine or in salvage treatment. Randomized trials are on going in these two se ttings High dose chemotherapy a not actually a standard treatment in germ c ell tumors.