[Palliative tumor chemotherapy and quality of life: what is optimal?]

In antitumor chemotherapy the combinations of drugs, dose and schedule are determined by the basic aims of the anticancer treatment. This also applies to the severity of side effects: their acceptability is different for different treatment aims. Where cancer chemotherapy is potentially curative, more side effects and transient reversible impairment of the quality of life must be accepted in comparison to tumor stages where treatment is purely palliative. The final aim of any palliative anticancer therapy must be to improve the quality of remaining life. An increased lifespan of poor quality is undesirable. These important criteria must be the guidelines in designing any palliative anticancer treatment. The criteria are different for different tumors, and within the same tumor for different risk groups. All these factors must be considered in selecting palliative chemotherapy. Examples of risk-adapted palliative chemotherapy are presented for three of the most frequent malignant tumors and their subgroups. For many tumors and their metastatic subgroups the criteria for optimal combinations of drugs, their dose, schedule and duration are being progressively refined. If this knowledge is applied properly in each case this should minimize the danger of unnecessary or even pointless impairment of life quality in the management of cancer patients.