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

• 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
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2008.03.008

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.