ABSTRACT
Several important issues must be addressed when any gynecologic cancer patient is being assessed for chemotherapy (see Table 1). The most important question is whether she is a chemotherapy candidate or not. This question is best answered by first considering the global health status of the patient, i.e., her physical, psychological, emotional, and quality-of-life status. Next in line for consideration is the therapeutic aim of the proposed treatment. The answers to these questions should be used to weigh the benefits and risks of chemotherapy and whether in fact it should be given. If cure is the therapeutic aim, then considerable short-term toxicity, as produced by intensive combination chemotherapy, is likely to be acceptable. Where short-term palliation is the aim, few, if any, side effects are acceptable. It must also be remembered that what is achievable can change as the disease evolves. Initial therapymay be aimed at obtaining a cure, but for most gynecologic malignancies, if relapse occurs, cure is not possible, although further chemotherapy may achieve temporary remission and may be indicated. Similarly, second-line chemotherapy may achieve a worthwhile remission in a patient who has had a long remission following first-line therapy. In general, however, when gynecologic cancer patients prove resistant to first-line chemotherapy, they are unlikely to respond to second-line therapy. In such a setting, second-line chemotherapy should therefore be considered experimental, with major toxicity being unacceptable.
