Opinion statement
Patient selection for cytoreductive surgery is a critical clinical assessment that defines the early management of ovarian cancer, and standardized patient-selection criteria for debulking surgery are lacking. The term “elderly” has been variably defined in the ovarian cancer debulking literature as being older than age 60, 70, or 80+ years of age. Multiple studies indicate the feasibility and acceptable complication rates for debulking surgery among women ≥70 years of age. These studies demonstrate improved survival among optimally debulked patients. There are limited data specifically addressing the advanced elderly, age ≥80; however, selected patients appear to be appropriate candidates. Further dedicated study addressing the patient selection for debulking surgery and treatment outcomes among elderly ovarian cancer patients is needed. In this article, outcome studies addressing the application of major gynecologic surgery, including cytoreductive surgery, in the elderly population are reviewed, and current areas of clinical investigation are highlighted.
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Hoskins WJ, McGuire WP, Brady MF, Homesley HD, Creasman WT, Berman M, Ball H, Berek JS: The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma. Am J Obstet Gynecol 1994, 170(4):974–979.
Hoskins WB, Bundy BN, Thigpen JT, Omura GA: The influence of cytoreductive surgery on recurrence-free and survival in small-volume stage III epithelial ovarian cancer: A Gynecologic Oncology Group Study. Gynecol Oncol 1992, 47:159–166.
Bristow RE, Montz FJ, Lagasse LD, Leuchter RS, Karlan BY: Survival impact of surgical cytoreduction in stage IV epithelial ovarian cancer. Gynecol Oncol 1999, 72(3):278–287.
Shirnisdottir I, Sorbe B: Prognostic factors for surgical outcome and survival in 447 women treated for advanced (FIGO-stages III-IV) epithelial ovarian carcinoma. Int J Oncol 2007, 30(3):727–734.
Winter WE, Maxwell GL, Tian C, Sundborg MJ, Rose GS, Rose PG, Rubin SC, Muggia F, McGuire WP: Tumor residual after surgical cytoreduction in prediction of clinical outcome in stage IV epithelial ovarian cancer: A Gynecologic Oncology Group Study. J Clin Oncol 2008, 26(1):83–89.
Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ: Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: A meta-analysis. J Clin Oncol 2002, 20(5):1248–1259.
Devolder K, Amant F, Neven P, van Gorp T, Leunen K, Vergote I: Role of diaphragmatic surgery in 69 patients with ovarian carcinoma. Int J Gynecol Cancer 2008, 18(2):363–368.
Zivanovic O, Eisenhauer EL, Zhou Q, Iasonos A, Sabbatini P, Sonoda Y, Abu-Rustum NR, Barakat RR: The impact of bulky upper abdominal disease cephalad to the greater omentum on surgical outcome for stage IIIC epithelial ovarian, fallopian tube, and primary peritoneal cancer. Gynecol Oncol 2008, 108(2):287–292.
Ries LA, Melbert D, Krapcho M, et al.: SEER cancer statistics review, 1975–2005. Bethesda, MD: National Cancer Institute; 2008.
Thigpen T, Brady MF, Omura GA, et al.: Age as a prognostic factor in ovarian carcinoma. The Gynecologic Oncology Group Experience. Cancer 1993, 71:606–614.
Balli S, Fey MF, Hanggi W, Zwahlen D, Berclaz G, Dreher E, Aebi S: Ovarian cancer: an institutional review of patterns of care, health insurance and prognosis. Eur J Cancer 2000, 36:2061–2068.
Winter WE 3rd, Maxwell GL, Tian C, et al.: Prognostic factors for stage III epithelial ovarian cancer: A Gynecologic Oncology Group Study. J Clin Oncol 2007, 25:3621–3627.
Chan JK, Urban R, Cheung MK, et al.: Ovarian cancer in younger vs older women: a population-based analysis. Br J Cancer 2006, 95:1314–1320.
Markman M, Lewis JL Jr, Saigo P, et al.: Impact of age on survival of patients with ovarian cancer. Gynecol Oncol 1993, 49:236–239.
Petignat P, Fioretta G, Verkooijen HM, et al.: Poorer survival of elderly patients with ovarian cancer: a population-based study. Surg Oncol 2004, 13:181–186.
Hightower RD, Nguyen HN, Averette HE, Hoskins W, Harrison T, Steren A: National Survey of Ovarian Carcinoma IV: patterns of care and related survival for older patients. Cancer 1994, 73(2):377–383.
Cress RD, O’Malley CD, Leiserowitz GS, Campleman SL: Patterns of chemotherapy use for women with ovarian cancer: a population based study. J Clin Oncol 2003, 21:1530–1535.
Ries LG: Ovarian cancer. Survival and treatment differences by age. Cancer 1993, 71(Suppl 2):S524–S529.
Moore DH, Kauderer JT, Bell J, Curtin JP, Van Le L: An assessment of age and other factors influencing protocol versus alternative treatments for patients with epithelial ovarian cancer referred to member institutions: A Gynecologic Oncology Group Study. Gynecol Oncol 2004, 94:368–374.
Friedman WH, Gallup DG, Burke JJ, Meister EA, Hoskins WJ: Outcomes of octogenarians and nonagenarians in elective major gynecologic surgery. Am J Obstet Gynecol 2006, 195:547–553.
Beni-Ami I, Vaknin Z, Schneider D, Halperin R: Perioperative morbidity and mortality of gynecologic oncologic surgery in elderly women. Int J Gynecol Cancer 2006, 16:452–457.
Aletti GD, Gostout BS, Podratz KC, Cliby WA: Ovarian cancer surgical resectability: Relative impact of disease, patient status, and surgeon. Gynecol Oncol 2006, 100:33–37.
Aletti GD, Dowdy SC, Podratz KC, Cliby WA: Analysis of factors impacting operability in stage IV ovarian cancer: rational use of a triage system. Gynecol Oncol 2007, 105:84–89.
Eisenhauer EL, Tew WP, Levine DA, Lichtman SM, Brown CL, Aghajanian C, Huh J, Barakat RR, Chi DS: Response and outcomes in elderly patients with stages IIIC-IV ovarian cancer receiving platinum-taxane chemotherapy. Gynecol Oncol 2007, 106:381–387.
Sharma S, Driscoll D, Odunsi K, Venkatadri A, Lele S: Safety and efficacy of cytoreductive surgery for epithelial ovarian cancer in elderly and high risk surgical patients. Am J Obstet Gynecol 2005, 193:2077–2082.
Burchim I, Altaras M, Fishman A: Age contrasts in clinical characteristics and pattern of care in patients with epithelial ovarian cancer. Gynecol Oncol 2002, 86:274–279.
Wright JD, Herzog TJ, Powell MA: Morbidity of cytoreductive surgery in the elderly. Am J Obstet Gynecol 2004, 190:1398–1400.
Uyar D, Frasure HE, Markman M, von Gruenigen VE: Treatment patterns by decade of life in elderly women (≥70 years of age) with ovarian cancer. Gynecol Oncol 2005, 98:403–408.
Cloven NG, Manetta A, Berman ML, Kohler MF, DiSaia PJ: Management of ovarian cancer in patients older than 80 years of age. Gynecol Oncol 1999, 73:137–139.
Moore KN, Reid MS, Fong DN, et al.: Ovarian cancer in the octogenarian: does the paradigm of aggressive cytoreductive surgery and chemotherapy still apply? Gynecol Oncol 2008, 110:133–139
Vergote I, Tropé C, Amant F, Kristensen G, Sardi J, Ehlen T, Johnson N, Verheijen R, Van der Burg M, Lacave A, Benedetti Panici P, Kenter G, Casado A, Mendiola C, Coens C, Stuart G, Pecorelli S, Reed N.: EORTC-GCG/NCIC-CTG randomised trial comparing primary debulking surgery with neoadjuvant chemotherapy in stage IIIC-IV ovarian, fallopian tube and peritoneal cancer. In: IGCS-12, 25–28 October 2008, Bangkok, Thailand. Int J Gynecol Cancer 2008 (oral presentation)
Bristow RE, Chi DS: Platinum-based neoadjuvant chemotherapy and interval surgical cytoreduction for advanced ovarian cancer: a meta-analysis. Gynecol Oncol 2006, 103(3):1070–1076.
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Gardner, G.J. Ovarian Cancer Cytoreductive Surgery in the Elderly. Curr. Treat. Options in Oncol. 10, 171–179 (2009). https://doi.org/10.1007/s11864-009-0114-4
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DOI: https://doi.org/10.1007/s11864-009-0114-4