Chemotherapy in patients with metastatic or relapsed germ-cell tumours

The optimal treatment in patients with poor prognosis germ-cell tumours (GC T), according to the International Germ Cell Cancer Collaborative Group (lG CCCG) classification, and in patients with refractory or relapsed disease a fter cisplatin-based chemotherapy is controversial. As the majority of pati ents will suffer systemic relapses, chemotherapy is the mainstay of treatme nt. However, the question of whether or not to use conventional-close or hi gh-dose chemotherapy (HDCT) in these patients arises. Prognostic factors ha ve recently been recognised to,aid in this decision, However, reliable data on chemotherapy as primary treatment in poor prognosis patients and as the first-salvage attempt in patients with relapsed or refractory GCT are lack ing. This report reviews the recent developments in first-line and salvage HDCT strategies and discusses the role of predictive factors for treatment outcome. (C) 2001 Harcourt Publishers Ltd.