Q. Will weekly chemotherapy cause less side effects than full dose chemotherapy in elderly patient?

Hello doctor,

I would like to know about weekly chemotherapy for Peritoneal cancer of 76-year-old lady. Instead of full dose chemotherapy at 21 days interval, weekly chemotherapy is done at a lower dose to have a less side effects. First chemo charged on her caused severe side effects like dysentery/diarrhea. Please confirm this whether this is really fruitful. For elderly patients, whether the weekly scheme is as effective and less toxic. Please help with your answer.

I am writing for my writing for my 76-year-old sister suffering primary peritoneal carcinoma. Before four years, one MD (Medicine) while treating her for asthma problem detected by clinical examination a huge lump in abdomen. He ordered for USG of lower abdomen and pelvis. The report says:

Kidneys: Both kidneys are normal in size but maintains shape, outline, and position.

Cortical echogenicity is increased with maintained corticomedullary differiention.

No evidence of any hydronephrosis, renal calculus or mass lesion is seen.

Right Kidney=7.4 cm, Left Kidney=7.5 cm.

Ureter: Both ureters are not visualized hence not dilated.

Urinary bladder: Urinary bladder is seen normal in size, shape and wall thickness.

No intraluminal lesion is seen.

Uterus and ovary: It is not visualized (removed in 1996).

Suprapubic region mesentery is grossly thickened and appears as SOL (10.4X5.4 cm) with displaced bowel loop around it.

Impression:

1. ?Mesenteric mass suggest CT scan

2. Bilateral small size kidneys with Grade I renal parenchymal changes.

Next seen by an oncosurgeon. He ordered for noncontrast CT of upper abdomen (Noncontast because as her creatinine level was 1.9 compared to a maximum of 1.0 for females.

CT scan of upper abdomen done and report shows:

The liver is of normal in size and is of normal contour and attenuation.

No IHBR dilation.

Gallbladder is well distended with normal wall thickness.

Pancreas is normal in size and attenuation.

Peripancreatic fat planes normal.

MPD not dilated.

Spleen is of normal size, contour and attenuation.

No focal lesions.

Sections through the lower abdomen show omental fat stranding and nodularity.

The Bilateral kidneys are mildly contracted.

The pelvicalyceal system are normal.

Adrenals are seen.

No evidence of any focal lesions.

No evidence of ascites.

No retroperitoneal lymphadenopathy is noted.

Visualized bowel loops reveal normal in position, caliber, and wall thickness.

Scoliosis noted with convexity towards left side.

Impression:

Omental stranding and nodularity.

The surgeon also asked for contrast enhance MRI of pelvis. The report shows:

MRI report patient postoperative case of ovarian malignancy (no documents available). Study reveals omental thickening and nodularity (caking). There is a focal protrusion of the omentum through a defect in the umbilicus (? postoperative).

Post Contrast study shows enhancement of the omentum. DWI images show restricted diffusion within the omentum. No abnormal lymphadenopathy seen. Bones under review are are within normal limits. Uterus and ovaries are not visualized (postoperative). There are minimal pelvic ascites.

On post Contrast study thin smooth peritoneal enhancement is seen with few nodules at places. Enhancement is also noted along the sigmoid and descending colon.

Impression:

Nodular cake like omental thickening, smooth peritoneal enhancement with nodularity at places in a patient with previous malignancy features suggest possibility of peritoneal carcinomatosis. (advise-omental biopsy)

Next core needle biopsy from omental mass was ordered. The report shows:

USG guided core biopsy from Omental mass. Microscopic examination section shows deposition of malignant gland formed by cuboidal cells within fibro collagenous tissue with desmoplastic stromal reaction.

Impression:

Adenocarcinoma Deposit.

I have forwarded to you four reports in respect of her for USG, CT scan, MRI, biopsy. Probably she is suffering from extra ovarian primary peritoneal cancer (EOPCC) which happens to candidates whose ovary/uterus already removed. For her Hysterectomy was done some 20 years back when biopsy report was normal. Please also note that her CA 125 is 2948 almost 80 times the normal value. Please intimate me in short whether any first dose of chemotherapy given caused heavy side effects like acute dysentery/diarrhea for her? Whether at this age of 76 chemo with one single drug is advisable? As per discussion with doctors here this peritoneal cancer resembles almost like ovarian cancer (treatment mode also same), although ovary removed some 20 years back.