Lorch A et al. – This article discussed the modalities of using of high-dose chemotherapy as salvage therapy in patients with germ-cell cancer (GCC). Though well-validated, guideline-based strategies result in high cure rates in patients with GCC, 5–10 % of GCC corresponding to 30 % of the patients diagnosed with metastatic disease, will experience disease progression or recurrence at some time point of their disease. This necessitates salvage treatment, which is more complex and less validated than first-line treatment, due to its rare and heterogenic patient cohorts and higher impact of prognostic factors, compared to other treatment scenarios. Considerations to be made before initiating salvage treatment include, verifying treatment failure with first-line agents; estimating the appropriateness and effectiveness of first-line treatment; estimation of the adequacy and the effectiveness of first-line treatment; searching metastatic sites and the extent of disease recurrence; and assessing known prognostic factors and choice of optimal salvage strategy, considering the aforementioned variables. In patients requiring salvage treatment, high-dose chemotherapy could be a rational choice; however, careful patient selection is necessary to prevent overtreatment and long-term toxicity.