The management of patients with advanced germ cell tumors. Seminoma and nonseminoma.

Treatment strategies for germ cell tumors have evolved substantially during the last decade and are directed by pretreatment prognostic factors that include histology (seminoma versus nonseminoma), primary site of disease, serum concentrations of lactate dehydrogenase and human chorionic gonadotropin, and the number of metastatic sites of disease. Patients with a high likelihood of achieving a complete response to therapy (CR0.5) are considered "good risk" and receive three or four cycles of cisplatin-based chemotherapy. Patients with a low likelihood of achieving a complete response (CR0.5) are considered "poor risk" and should be considered for innovative treatment strategies with the intent of increasing the proportion of patients who are cured. One approach in patients with "poor risk" disease uses early treatment with high-dose chemotherapy and autologous bone marrow transplantation. In addition, effective salvage regimens are available for those patients who fail first-line therapy.