Before starting chemotherapy, kidney function should be evaluated (GFR) as well as an EKG. Cisplatin, etoposide, bleomycin and ifosfamide are considered the most effective for treatment of malignant germ cell tumors.
If metastases are found, the primary treatment is almost always chemotherapy with combinations of cisplatin, etoposide, and bleomycin. Depending on the extent of the disease, 3-4 courses are usually administered. The accumulative bleomycin dose should not surpass 360,000 IE due to the increase in risk of lung damage.
Recently, one course of carboplatin has been introduced as adjuvant treatment for stage I seminoma with a high risk profile. For seminoma, bleomycin can be excluded for stage III, and instead give 4 EP courses, which corresponds to 3 BEP courses. For recurrence, TIP treatments are used as any internationally established standard second line treatments do not exist. Alternatively, paclitaxel-gemcitabin can be used and possibly combined with cisplatin or oxaliplatin. Other variations are EMA-CO (especially for choriocarcinoma), VIP, VeIP, and OI.
High-dose chemotherapy with stem cell support (HMAS) is used for recurrence during the first two years.
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