Combination Chemotherapy in Treating Children With Newly Diagnosed Malignant Germ Cell Tumors

DISEASE CHARACTERISTICS:

   - Histologically confirmed newly diagnosed extracranial germ cell tumors, including 1 of
   the following types:

      - Yolk sac carcinoma (endodermal sinus tumor)

      - Embryonal carcinoma

      - Choriocarcinoma

      - Teratoma with mixed malignant elements (malignant teratoma)

   - High-risk disease, defined as stage III or IV extragonadal germ cell tumors

   - Must be enrolled on study within 21 days of diagnostic surgical procedure

PATIENT CHARACTERISTICS:

Age

   - 21 and under (at original diagnosis)

Performance status

   - ECOG 0-2

      - Karnofsky 50-100% (in patients over 16 years of age)

      - Lansky 50-100% (in patients 16 years of age and under)

Life expectancy

   - At least 2 months

Hematopoietic

   - Absolute neutrophil count at least 1,000/mm^3

   - Platelet count at least 100,000/mm^3 (transfusion independent)

   - Hemoglobin at least 10.0 g/dL (transfusion allowed)

Hepatic

   - Not specified

Renal

   - Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min OR

   - Creatinine based on age as follows:

      - No greater than 0.8 mg/dL (5 years and under)

      - No greater than 1.0 mg/dL (6-10 years)

      - No greater than 1.2 mg/dL (11-15 years)

      - No greater than 1.5 mg/dL (over 15 years)

Pulmonary

   - FEV_1/FVC greater than 60% OR

   - Children who are uncooperative must meet all of the following criteria:

      - No dyspnea at rest

      - No exercise intolerance

      - Pulse oximetry greater than 94%

Other

   - Not pregnant or nursing

   - Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy

   - Not specified

Chemotherapy

   - No prior chemotherapy

Endocrine therapy

   - Not specified

Radiotherapy

   - No prior radiotherapy

Surgery

   - See Disease Characteristics