ABSTRACT
Background: Many researches lately warned that carrying extra weight means carrying extra cancer risk specially breast cancer. It is well known that obesity is related to cardiovascular disease and diabetes, but not many who are aware that shedding pounds could reduce their risk of getting cancer
Methods: In Alexandria clinical oncology department [ ACOD] , One hundred and twenty obese breast cancer patients' were prospectively recruited, they received FAC chemotherapy calculated according to either the actual [group I ] or ideal body surface area [group II] and the treatment outcome was analyzed. Pretreatment demographics and clinical characteristics collected included body mass index [BMI], actual and ideal bodysurface area [BSA], tumor stage and grade, estrogen receptor status, ECOG performance status, planned dose and schedule. Also, pretreatment complete blood picture, liver function tests, renal function test and ECHO Ejection Fraction was requested. The patients were followed prospectively during chemotherapy to evaluate the treatment outcome and the toxicity profile. Results were collected and statistically analyzed
Results: This study confirmed that the FAC standard regimen dosed according to the ideal body surface area is characterized by an accepted degree of hematopoietic toxicities that was much less than that took place in the actual body sulface area dosed arm and can be applied very closely to the intended dose and time schedule. The most common acute laboratory toxicity was the hematological toxicity that was significant on comparing the Hemoglobin level between the first cycle and sixth cycle [p value = 0.002 ] in the actual body surface area arm but of no significance in the ideal body surface area dosed arm. There was an overall significant dijfererzce as regard the hemoglobin level between group I and II with p value of <0.0001. Also, there was an overall significant difference as regard the WBCs counts between groups I and II with p value of 0.002. Regarding the liverfunction tests, there was an overall significant difference as regard the ALT level between group I and II with p value of < 0.0001. The same pattern was also noted between the 2 groups as regards renal toxicity, gastrointestinal toxicity, nail discoloration and hair loss
Conclusion: Based on our study; there was a trend towards a higher toxicity profile in the obese females who received FAC adjuvant chemotherapy for breast cancer dosed according to the actual body surface area than those who were dosed according to the ideal surface area who had better tolerance. On the other hand no significant differences as regard the treatmentfailure and disease free survival so far.Still further trials to specmcally investigate the most appropriate tool for calculating the chemotherapy dosage in obese patients. These studies need to be prospectively randomized studies with innovative approach and good scienujic conduct. On the other hand 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