الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
A common problem that is facing clinicians is the difficulty in adequately comparing the impact of different dosing practices on the clinical efficacy and toxicity profile of chemotherapy in obese cancer patients. The WHO available data show that 31 percent of adults age 20 and older have a body mass index (BMI) of 30 or greater, compared with 23 percent in 1994 which reflects an increase of 7.6 percentage points since 1994. (160)
The nature of the relationship between chemotherapy dose intensity and clinical outcome, in particular, remains the subject of much controversy. In the practical settings, obese patients always experience unplanned reduction in the chemotherapy dose. (165) Oncologists have reached a crossroads in higher-dose chemotherapy for obese patients with breast cancer. Is higher-dose chemotherapy going anywhere, or should we allow it to wither on the vine?
Our study aimed to evaluate the toxicity profile of the administration of FAC chemotherapy for obese cancer breast female patients on conventional base according to both the ideal and actual body surface area. We aimed to provide detailed information on their practicability with regard to acute hematological toxicities, impact on liver and kidney function tests, GIT toxicities, hair loss, nail discoloration, cardiotoxicity, erythema and rash. This aim was always missed in the previous oncological studies or based on retrospective studies that were biased by being accepting 5% dose modifications and lack of cycle specific data.
In view of the results of our study, it was very obvious that the toxicity profile of the patients who were dosed according to the actual body surface area was significantly higher than that in the patients dosed according to the ideal body surface area that was most remarkable in acute hematological toxicities and acute GIT toxicities, hair loss and nail discoloration.
There was unplanned dose modification in the group of patients’ whose doses were calculated according to the actual body surface area due to change of weight from cycle to cycle, this change still was not statistically significant. However, it might be much significant in the metastatic settings where the patients’ performance status is worse and oncologists by that time might count on planned dose reduction schedules or might be obliged to undergo unplanned dose reduction. (165)
There was no significant statistical difference regarding treatment failure, time to progression, disease free survival and overall survival at a median of fifty six weeks. Still, longer follow up of the patients with an update release is required in order to assess the Disease Free Survival, Overall survival and Time to Progression.
Further prospective randomized trials with innovative approach and good scientific conduct are needed to specifically investigate the most appropriate tool for calculating the chemotherapy dosage in obese patients. Also, further trials to assess and evaluate the efficacy and toxicity profile of the dose-dense administration of chemotherapy.
Intensifying chemotherapy with more active drugs that have less toxicity profile, better tolerance and cost effective. Also, we might consider introducing the biological agents in conventional combination chemotherapy regimens.
Concrete efforts and substantial investment on the part of policymakers, educators, clinicians, employers, and schools to promote physical activity and healthful dietary practices as a cultural norm is of utmost importance to maintain normal body weight, and should be set as a global public health priority.