Chemotherapy for germ cell cancer is usually indicated in patients who present with metastatic disease, suffer relapses, or progress after their initial treatment. Rarely is chemotherapy needed in the palliative treatment of refractory patients. However, more recently chemotherapy has been demonstrated to benefit also patients with early stages of seminoma as well as nonseminoma. Therefore, the most recent European consensus guidelines on treatment and diagnosis of germ cell cancer list chemotherapy as an alternative treatment option in the early tumor stages I and II. The application of chemotherapy represents a challenge for both patients and the treating physician who must be experienced with a broad array of chemotherapy regimens and competent in their application. Particularly the treatment of patients with advanced tumor stages requires good clinical skills on the part of the treating oncologist. If excessive toxicity is to be avoided and a curative treatment option maintained, overtreatment as well as undertreatment are notorious pitfalls.
