Principles of chemotherapy

Chemotherapy plays a major role in the treatment of patients with gynecological malignancies. In general, chemotherapy has a smaller therapeutic window compared with drugs of other types; hence, the potential for severe adverse effects associated with chemotherapy has made appropriate patient and drug selection critical. Before initiating treatment of any patient with a chemotherapeutic agent, the following issues should be considered: Tumor characteristics: • The primary malignant diagnosis should be verified histologically. • The first recurrence should be verified preferably by cytology or histology. (Ideally, recurrent disease should be verified by cytology or preferably histology; it is acknowledged that this is not always possible especially in ovarian cancer.) • The extent of disease. • The likelihood of tumor response (e.g. type of cancer, rate of disease progression). Patient characteristics: • The patient’s age. • The patient’s general state of health (performance status). • Comorbidities (such as heart, liver, and kidney diseases). • Previous cancer treatments (response and adverse effects). • The patient’s psychosocial status. Goals of treatment: • Cure • Tumor control to prolong survival. • Palliation of symptoms.