Surgery and Combination Chemotherapy in Treating Children With Extracranial Germ Cell Tumors

Inclusion Criteria:

   - Extracranial germ cell tumor that contains 1 of the following malignant histologies:
   NOTE: Mixed germ cell tumors that include mature/immature teratoma are eligible
   provided 1 of the 3 histologies listed above is also present in the tumor.

      - Yolk sac tumor

      - Embryonal carcinoma

      - Choriocarcinoma

   - Low-risk disease (closed to accrual as of 01/20/10)

      - Stage I gonadal tumors (ovarian and testicular)

      - Must have undergone complete surgical and radiologic staging to exclude the
      possibility of > stage I disease

   - Intermediate-risk disease

      - Stage II, III, or IV malignant testicular GCT

      - Stage II or III malignant ovarian GCT

      - Stage I or II malignant extragonadal GCT

      - Previously stage I gonadal patients who have relapsed on the low-risk
      (observation) stratum of this study(closed to accrual as of 01/20/10)

      - Patients with immature teratoma or mature teratoma who relapse with a malignant
      component

   - No patients with any of the following diagnoses:

      - Stage IV ovarian and stage III-IV extragonadal GCT

      - Intracranial GCT

      - Pure mature or immature teratoma, pure dysgerminoma, or seminoma

      - Patients with a non-germ cell component in their GCT (e.g., primitive
      neuroectodermal tumors or rhabdomyosarcoma)

   - Alpha-fetoprotein and beta human chorionic gonadotropin tumor markers known

      - If > 5 days have elapsed from the time of obtaining original markers, tumor
      markers must be repeated before enrollment of low-risk patients and before
      initiating therapy in intermediate-risk patients (the results of the repeated
      tumor markers do not have to be known at the time of study enrollment)

   - Must be enrolled within 6 weeks of original diagnostic surgery

   - Creatinine clearance or radioisotope GFR ≥ 70 mL/min OR a serum creatinine based on
   age/gender as follows:

      - ≤ 0.4 mg/dL (for patients 1 to 5 months of age)

      - ≤ 0.5 mg/dL (for patients 6 to 11 months of age)

      - ≤ 0.6 mg/dL (for patients 1 year of age)

      - ≤ 0.8 mg/dL (for patients 2 to 5 years of age)

      - ≤ 1.0 mg/dL (for patients 6 to 9 years of age)

      - ≤ 1.2 mg/dL (for patients 10 to 12 years of age)

      - ≤ 1.4 mg/dL (for female patients ≥ 13 years of age)

      - ≤ 1.5 mg/dL (for male patients 13 to 15 years of age)

      - ≤ 1.7 mg/dL (for male patients ≥ 16 years of age)

   - No prior chemotherapy

   - No prior radiotherapy