Ovarian cancer in the elderly: feasibility of surgery and chemotherapy in 89 geriatric patients

Abstract

Gynecological oncologists are faced with an increasing proportion of geriatric ovarian cancer patients. Comorbidities are frequently a matter of concern in this age group, and what is adequate treatment for such patients is still debated. The aims of this study were to analyze the feasibility of standard surgery and chemotherapy in a series of elderly ovarian cancer patients (>/=70 years) and to investigate the influence of age (70-75 vs >75 years) on survival. We retrospectively evaluated 89 elderly patients treated at our department between 1985 and 2005. Comorbidities, type of surgical procedure, complications, drugs and schedules of chemotherapy, number of cycles, toxicity, and clinical outcome were registered. Comorbidities were present in 71.9%. Only six patients were inoperable. Among the 83 patients who underwent surgery, 76.4% received adequate surgical treatment. Severe postoperative complications occurred in 16.8%, operative mortality was zero. A total of 801 cycles of chemotherapy were administered to 77 patients (median 10; range 1-38). Overall, G3-G4 toxicity was documented in 61.0%. The rates of dose reduction, treatment delay, and discontinuation were 13.0%, 20.7%, and 3.9%, respectively. Patients who received adequate surgery and those with residual disease <1 cm did significantly better than their counterparts (P= 0.04 and P < 0.001, respectively). No difference in survival according to age (70-75 vs >75 years) was found. Standard surgery and chemotherapy were feasible in elderly ovarian cancer patients. The type of surgery and the amount of residual disease, but not the age of the patients, significantly influenced the clinical outcome.

Feasibility and Safety of Extensive Upper Abdominal Surgery in Elderly Patients with Advanced Epithelial Ovarian Cancer

“…This corresponds with the results of previous studies (10, 12, 13). However, our data raised a concern that the incorporation of upper abdominal procedures may increase the frequency of specific complications and may cause more physical burden to the elderly patients who underwent EUAS procedures.…”

Significance of age and comorbidity on treatment modality, treatment adherence, and prognosis in elderly ovarian cancer patients

“…This indicates that there might be a group of elderly who could benefit from more aggressive therapy than is offered to them today. Indeed, studies have shown both cytoreductive surgery and combination chemotherapy to be feasible in elderly OC patients [24,25]. More toxicity of TC treatment might be expected in the elderly [26], and several strategies have been described to reduce this problem.…”

Delay in chemotherapy administration impacts survival in elderly patients with epithelial ovarian cancer

“…Patients who are perceived to be elderly or frail may receive less aggressive surgery, non-standard chemotherapy regimens, or may be provided less opportunity to participate in clinical trials [4,6,8,12]. For instance, while it is well established that platinum-based adjuvant chemotherapy improves progression-free and overall survival and is therefore standard of care for treatment of EOC [13][14][15][16], elderly EOC patients frequently do not receive standard doublet chemotherapy [8,12,[15][16][17][18][19][20][21][22][23]. Therefore, while intrinsic patient factors contribute to decreased overall survival, there is likely an effect related to differences in patient treatment.…”