title: 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.
  
  
  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.
authors.affiliation: University of Oklahoma Health Sciences Center, Division of Gynecologic Oncology, Oklahoma City, Oklahoma 73103, USA. Kathleen-moore@ouhsc.edu
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Moore
authors.forename: Monica S
authors.initials: MS
authors.lastname: Reid
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Fong
authors.forename: Tashanna K N
authors.initials: TK
authors.lastname: Myers
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Landrum
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Moxley
authors.forename: Joan L
authors.initials: JL
authors.lastname: Walker
authors.forename: D Scott
authors.initials: DS
authors.lastname: McMeekin
authors.forename: Robert S
authors.initials: RS
authors.lastname: Mannel
mesh_terms: D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000209:etiology; D017024:Chemotherapy, Adjuvant; D015897:Comorbidity; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D017239:Paclitaxel / Q000008:administration & dosage; D012189:Retrospective Studies
chemical_list: D009944:Organoplatinum Compounds; D003520:Cyclophosphamide; D017239:Paclitaxel