ABSTRACT

Germ-cell tumours occur predominantly between the ages of 18 and 45 years. The incidence is increasing in most Western countries, such that in young men it has risen from 6 per 100000 during the 1960s to just over 12 in the early 1990s. Fortunately, the success of combination chemotherapy has prevented this being translated into a problem of increasing mortality. The introduction of cisplatin in combination with vinblastine and bleomycin was a seminal advance in the treatment of patients with metastatic disease [1]. Further improvement in treatment results has come from the replacement of vinblastine by etoposide in this regimen; the combination of bleomycin, etoposide and cisplatin (BEP) currently represents a standard approach internationally [2-4]. Furthermore, there has been publication of sufficient long-term results to judge that chemotherapy is curative. For example, in 229 patients treated in Indiana between 1974 and 1980, recurrence more than three years after chemotherapy was rare [5]. This is supported by a decade of Royal Marsden Hospital results in 320 patients treated between 1976 and 1985 [6].