Stage 23 and 4 teratoma

♦ Standard treatment for metastases—Bleomycin

—Etoposide —Cisplatin

—intermittent group (75%) —poor prognosis (50%)

♦ Role of high-dose chemotherapy, marrow or stem cell transplantation—not clear

♦ Chemotherapy side-effects common —nephropathy —neuropathy

—ototoxiciy —myelosupression

—Bleomycin pneumonitis (fatal in 10%)

♦ Results better in specialized centres

♦ Monitor response—scans, tumour markers

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