title: Cytoreduction and HIPEC after neoadjuvant chemotherapy in stage IIIC-IV ovarian cancer. Critical analysis in elderly patients.
abstract: OBJECTIVE
  The aim of our study was to evaluate postoperative morbidity and mortality, disease-free and overall survival in patients older than 75 years undergoing interval debulking after neoadjuvant chemotherapy and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC).
  
  
  METHODS
  Were included a series of consecutive patients diagnosed with stages IIIC/IV ovarian carcinoma, intervened after neoadjuvant systemic chemotherapy (paclitaxel and carboplatin) between January 2008 and June 2013. After completion of cytoreduction HIPEC was administered using paclitaxel (60mg/m(2)) or cisplatin (75mg/m(2)). We analyzed and compared the results of postoperative morbidity and mortality, disease-free survival and overall survival in patients ≥75 years compared to patients with lower ages intervened in the same time period.
  
  
  RESULTS
  From a total of 66 patients tested, 9 patients were ≥75 years (14%). Grade I-IV morbidity was significantly higher in patients ≥75 years (78% vs 35%, p<0.05) as well as grade III-IV disease (56% vs 16%, p<0.05). There were no procedure-related mortality. In patients ≥75 years the median disease-free survival was 6 months (95% CI: 3.5-8.5 months) vs 24 months (95% CI: 10.5-37.5 months) in younger patients. The median overall survival in patients ≥75 years was 13 months (95% CI: 4.7-21.3), not having reached at time of analysis of the database in younger patients.
  
  
  CONCLUSIONS
  Patients ≥75 years received no benefit in prognosis after interval cytoreduction with HIPEC and paid a high price in terms of postoperative morbidity. This age group should be excluded from this therapeutic procedure.
authors: Department of Surgery, Peritoneal Carcinomatosis Unit, Department of Surgery, Virgen De La Arrixaca University Hospital, Murcia, Spain. Electronic address: cascalescirugia@gmail.com.
authors: P
authors: P
authors: Cascales-Campos
authors: Department of Surgery, Peritoneal Carcinomatosis Unit, Department of Surgery, Virgen De La Arrixaca University Hospital, Murcia, Spain.
authors: J
authors: J
authors: Gil
authors: Department of Surgery, Peritoneal Carcinomatosis Unit, Department of Surgery, Virgen De La Arrixaca University Hospital, Murcia, Spain.
authors: E
authors: E
authors: Gil
authors: Department of Medical Oncologist, Peritoneal Carcinomatosis Unit, Virgen De La Arrixaca University Hospital, Murcia, Spain.
authors: E
authors: E
authors: Feliciangeli
authors: Department of Surgery, Peritoneal Carcinomatosis Unit, Department of Surgery, Virgen De La Arrixaca University Hospital, Murcia, Spain.
authors: V
authors: V
authors: López
authors: Department of Surgery, Peritoneal Carcinomatosis Unit, Department of Surgery, Virgen De La Arrixaca University Hospital, Murcia, Spain.
authors: A Gil
authors: AG
authors: Gonzalez
authors: Department of Surgery, Peritoneal Carcinomatosis Unit, Department of Surgery, Virgen De La Arrixaca University Hospital, Murcia, Spain.
authors: J
authors: J
authors: Ruiz-Pardo
authors: Department of Gynecologic Oncology, Peritoneal Carcinomatosis Unit, Virgen De La Arrixaca University Hospital, Murcia, Spain.
authors: A
authors: A
authors: Nieto
authors: Department of Surgery, Peritoneal Carcinomatosis Unit, Department of Surgery, Virgen De La Arrixaca University Hospital, Murcia, Spain.
authors: P
authors: P
authors: Parrilla
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D017239:Paclitaxel / Q000627:therapeutic use; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D016190:Carboplatin; D017239:Paclitaxel
keywords: Cytoreduction; Elderly; Hipec; Neoadjuvant; Ovarian Cancer