High-dose chemotherapy in gynaecological cancers: does more mean better?

Evidence of the potential importance of planned dose intensity and its effect on patient outcome is based predominantly on the retrospective analysis of randomized trials. These have been subject to criticism on methodological grounds and should be considered as hypothesis-generating rather than proof of the importance of dose intensity. The relationship between chemotherapeutic dose and outcome of patients with gynaecological cancers has been investigated mainly in patients with advanced ovarian cancer. The literature is made up predominantly of small phase I-II studies demonstrating the feasibility of dose intensification strategies, but there is a paucity of large randomized trials. Although the 'more is better' approach may be intuitively appealing and is supported by some data, it must be demonstrated to translate into increased survival.