How do you approach the treatment of teen patients with recurrent mediastinal germ cell tumor who have failed standard therapy, radiation, and HD therapy/stem cell rescue?   

The query failed to delineate whether this was seminoma or non-seminoma, but probably does not matter in this advanced stage of a heavily treated patient. Also failed to address the anatomical location of active cancer. Whether this is a teen or older patient is irrelevant. For mediastinal seminoma...