Patients with good-prognosis germ cell tumors are those with the highest likelihood of cure. By identifying pre-treatment risk assignment, these patients may be treated with the most efficacious and least toxic regimens, while poor-risk patients may be selected to receive potentially more toxic combinations to optimize cure rates. The lack of uniform criteria of good-risk disease has been addressed by an international consortium, the International Germ Cell Cancer Collaborative Group. Recommendations for three risk strata, defined by serum tumor markers and specific sites of disease provide reproducible subsets of good-, intermediate-, and poor-risk populations that allow international trial collaborations and direct comparison of good-risk therapies and outcomes. Despite different criteria defining good-risk disease, trials in these patients have successfully eliminated bleomycin from combination regimens, have reduced the number of cycles of therapy, and have proven that carboplatin cannot replace cisplatin. As a consequence of controlled studies, three cycles of bleomycin, etoposide, and cisplatin (BEP) or four cycles of etoposide and cisplatin, using a 5-day etoposide schedule have been established as American standards. In Europe, four cycles of BEP using the 3-day etoposide schedule is considered the standard schedule. Because the schedule of etoposide is not uniform, prospective evaluation is necessary to determine whether the 3-day European standard is the equivalent of the 5-day American standard.
