It is 2019, and it is my 6th year in field of Oncology. Over last few years in oncology the most important aspect of cancer treatment which I learned using "appropriate dose"
In private practice I have seen innumerable Times where a patient it is given less than optimum doses from the first cycle itself to avoid toxicities of chemotherapy. This is more common practice as we approach relatively smaller City. To adjust a chemotherapy doses based on toxicity from second cycle onwards is a common practice. However never exposing a person to full doses of chemotherapy is just" playing safe".
I will give you a simple example , high dose methotrexate which is a risky chemotherapy in bone cancer treatment is usually given at 10gm per metre square. Hence on an average for a body surface area of 1.6, dose of methotrexate is usually 16 grams. However, to avoid toxicity often a much low dose somewhere near 10 grams is administered. For obvious reasons there will be less toxicity, but for all the more obvious reason there will be less effect also.
Complete response in the form of 100% necrosis after chemotherapy is even proven to increase survival in many cancers eg, breast cancer, bone cancer etc
This strategy of " playing safe" may be appropriate in metastatic disease or when patient is not fit for full dose of chemotherapy. But in case of preoperative chemotherapy for postoperative chemotherapy where our intention is cure, a patient must receive full doses of chemotherapy. Many of our government health schemes where management of chemotherapy toxicity is poorly compensated also contribute to the general practice of giving "relatively safe dose" of chemotherapy.
In today's world where litigation is common it is tempting to play safe. However patient should be explained that cancer treatment is not simple and complications are part of treatment. This is especially true in curative setting because if the cancer relapse due to inadequate dosage, it usually becomes metastatic and than we can not cure it
Here is an example of osteosarcoma treated with full dose of chemotherapy. We achieved a complete response in surgical specimen.
