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High-dose chemotherapy in germ cell tumors: an old story still young.

Giovanni Rosti

Germ cell tumours represent a model of curable solid tumours. In stage 1 and 2 more than 90% the patients can achieve cure, while in advanced cases such a goal is achieved in 70-80%. For metastatic cases the standard treatment has been for more than three decades the combination of cisplatin, etoposide and bleomycin (PEB) for three or four courses depending on the prognostic category (good or intermediate/poor). Surgery on the residuum is a fundamental part of the whole program, especially in non seminoma and all efforts have to be undertaken to remove residual disease. But despite these good results, a not negligible minority of patients do relapse usually in the first one or two years. Cure can still be achieved with second line chemotherapy in 25-40% of the patients, depending on type of relapse