Background: In 2012, the American Society of Clinical Oncology issued a guideline urging health care professionals to "routinely use an obese patient's actual body weight, rather than an ideal body weight or other estimate, to calculate the appropriate dose of nearly all chemotherapy drugs." This guideline does not address dosages for patients who are morbidly obese (body mass index ≥ 40) and receiving concomitant chemotherapy and radiation. Methods: This report describes a single-institution experience intended to address the issue of appropriate dosages for this patient population. Results: Among 1,886 cancer patients who received curative thoracic radiation at the Mayo Clinic, 16 (0.8%) were morbidly obese and received concomitant chemotherapy and radiation. Charlson morbidity scores for the cohort ranged from 2 to 9, and 10 patients had esophageal cancer. Ten of 16 patients received an initial chemotherapy dose reduction, and 4 of these patients experienced major adverse events, including 1 death. Similarly, among the 6 patients who received full-dose chemotherapy at the beginning of treatment, 2 had major adverse events. Nine patients went on to have their cancers resected, but no differences in survival were apparent among patients who received initial dose reductions and those who did not. Conclusions: This single-institution experience remains limited. However, in view of the severe toxicity observed in this cohort, chemotherapy dose reductions seem appropriate in specific instances. Clinicians should also consider prescribing newer chemotherapy regimens that may be better tolerated in morbidly obese patients with cancer.
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