Review High-dose chemotherapy in germ-cell tumors

The majority of patients with advanced-stage germ-cell tumor are curable by cisplatin-based chemotherapy, but about 10 % of those in the good-risk and 30%-50 % in the poor-risk groups will experience relapse. Patients in first relapse have a 60 % chance of entering a second complete remission and a 15%-25 % probability that it will be durable. Regimens of high-dose chemotherapy with hematopoietic stem-cell support have been developed specifically for this patient population: they are usually based on combinations of etoposide, cyclophosphamide, ifosfamide and, originally, double-dose cisplatin or, nowadays, high-dose carboplatin. The role of high-dose chemotherapy was studied initially in salvage and later in first-line treatment. Four hundred thirty-six patients who received high-dose salvage chemotherapy have been reported, 96 (22%) of whom have obtained long