Why do our patients get chemotherapy

Some years ago, I treated a 21-year-old woman. During her first pregnancy, an enlarging mass appeared in her right leg. Diagnostic procedures done after delivery indicated that she had alveolar rhabdomyosarcoma. She was referred to the cancer center for isolated limb perfusion, which was deemed impossible due to inguinal masses encountered during the attempt to canalize the femoral vessels. A computed tomography scan showed peripheral micronodules in both lungs, after which she was referred to the medical oncology department for systemic chemotherapy. By then, the primary tumor was a fungating mass requiring morphine for pain control. Treatment with cyclophosphamide, doxorubicin and vincristine led to a prolonged hospital admission for bacterial sepsis, during which she was visited by her husband daily late after work and on Sundays by her family and the baby. On the subsequent cycle, and despite reduced chemotherapy doses, she again experienced severe hematological toxicity and no antitumor effect or decreased requirement of narcotics. Next, single-agent doxorubicin was administered in the outpatient clinic as an attempt to preserve quality of life. Still no antitumor or symptom response was achieved and multiple hospital admissions due to hematological toxicity ensued. Eventually, ifosfamide was prescribed in progressively lower doses due to increasing hematological toxicity but still without clinical benefit. She finally died of fungal sepsis, 3 months after being referred to the medical oncology department.