How do you manage a young patient with mediastinal nonseminomatous germ cell tumor that has relapsed after primary treatment with four cycles of VIP?

How do you manage a young patient with mediastinal nonseminomatous germ cell tumor that has relapsed after primary treatment with four cycles of VIP?

• TIP x 4 cycles
• Surgical resection if feasible, consideration of further chemo after surgery
• Auto bone marrow transplant (or tandem transplant)
• Surgical resection if feasible, consideration of transplant after surgery
• Other