title: Intensified chemotherapy with stem-cell rescue in germ-cell tumors.
abstract: BACKGROUND
  Based on the high chemosensitivity of germ-cell tumors (GCTs), the concept of high-dose chemotherapy (HDCT) has been developed worldwide and investigated through many clinical trials. It has been carried out in different clinical settings, ranging from resistant or absolute refractory disease to chemosensitive relapse. HDCT with stem-cell support has been also explored as a part of first-line strategy for poor-prognosis patients.
  
  
  METHODS
  Our review summarized results from clinical trials evaluating the role of HDCT in patients with advanced GCTs. So far available data were obtained through a Medline search of English-language literature.
  
  
  RESULTS
  Several phase II trials and retrospective series have shown a possible benefit for GCT patients with recurrent disease as well as in first-line setting. Despite these results, data derived from randomized phase III studies failed to demonstrate any survival advantage for HDCT over conventional chemotherapy.
  
  
  CONCLUSIONS
  The role of HDCT in GCTs remains controversial. We need new prospective studies based on prognostic factors with multiple transplants of carboplatin and etoposide as the preferred high dose regimen. At present, based mainly on retrospective and phase II studies, HDCT may represent a therapeutic option for patients with primary refractory disease or for those with a second or further relapse.
authors.affiliation: Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano. matteo.simonelli@cancercenter.humanitas.it
authors.forename: M
authors.initials: M
authors.lastname: Simonelli
authors.forename: G
authors.initials: G
authors.lastname: Rosti
authors.forename: G L
authors.initials: GL
authors.lastname: Banna
authors.forename: P
authors.initials: P
authors.lastname: Pedrazzoli
mesh_terms: D019008:Drug Resistance, Neoplasm; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D016879:Salvage Therapy; D033581:Stem Cell Transplantation