Ovarian cancer in the octogenarian: Does the paradigm of aggressive cytoreductive surgery and chemotherapy still apply?

Abstract Objective The cornerstone of therapy for advanced ovarian cancer is cytoreductive surgery (CRS) followed by platinum based chemotherapy. Optimal management for very elderly women (> 80) is unclear. This study sought to review the experience with treating ovarian cancer in this population...

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Bibliographic Details
Published in:	Gynecologic oncology Vol. 110; no. 2; pp. 133 - 139
Main Authors:	Moore, Kathleen N, Reid, Monica S, Fong, Daniel N, Myers, Tashanna K.N, Landrum, Lisa M, Moxley, Katherine M, Walker, Joan L, McMeekin, D. Scott, Mannel, Robert S
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-08-2008
Subjects:	Aged, 80 and over Antineoplastic Combined Chemotherapy Protocols - therapeutic use Arrhythmias, Cardiac - etiology Chemotherapy, Adjuvant Comorbidity Complications Cyclophosphamide - administration & dosage Elderly Female Gero-oncology Gynecologic Surgical Procedures - adverse effects Gynecologic Surgical Procedures - methods Hematology, Oncology and Palliative Medicine Humans Neoplasm Staging Obstetrics and Gynecology Organoplatinum Compounds - administration & dosage Ovarian cancer Ovarian Neoplasms - drug therapy Ovarian Neoplasms - pathology Ovarian Neoplasms - surgery Paclitaxel - administration & dosage Retrospective Studies Gero-oncology Complications Elderly Ovarian cancer
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Summary:	Abstract Objective The cornerstone of therapy for advanced ovarian cancer is cytoreductive surgery (CRS) followed by platinum based chemotherapy. Optimal management for very elderly women (> 80) is unclear. This study sought to review the experience with treating ovarian cancer in this population. Materials and methods This is a retrospective analysis of patients treated between 1991 and 2006. Outcomes included post-operative complications, chemotherapy received and overall survival. Statistical analysis was performed with SAS v.9.1. Results 85 patients were identified with a mean age of 84 years. 86% of patients presented with advanced disease. Primary CRS was performed on 80%. Among patients with advanced disease who underwent either primary (68) or interval debulking (2), 74% were left with < 1 cm residual disease. Post-operative complications were common with 15% of patients suffering cardiac or pulmonary complications, over 10% with prolonged ileus, wound complications or mental status changes and over 30% requiring transfusion or antibiotics. Death prior to hospital discharge and within 60 days of surgery occurred in 13% and 20%. Among patients who underwent CRS, 13% were unable to receive indicated adjuvant therapy. Among those who were treated, 25% were treated with single agent platinum and 43% completed < 3 cycles. Two-year overall survival for those who underwent CRS followed by adjuvant therapy is 51%. Conclusions Our data suggests that patients > 80 may not tolerate combination surgery and chemotherapy. The extremely high proportion of post-operative complications and relatively high proportion of post-operative deaths argues for a more prudent approach to this group of patients.
ISSN:	0090-8258 1095-6859
DOI:	10.1016/j.ygyno.2008.03.008