Management of ovarian cancer in patients older than 80 years of age

Objective. The objective of this study was to examine the treatment, associ ated morbidity, and survival in very elderly patients with epithelial ovari an cancer, Methods. A retrospective analysis of patients 80 years of age and older tre ated for epithelial ovarian cancer by the Gynecologic Oncology faculty at t he University of California Irvine was performed. Results, Eighteen patients were older than 80 years of age at the time of d iagnosis of ovarian cancer. Median age was 83 years (range 80-86 years). Th ere were 2 stage I, 10 stage IIIC, 4 stage VI, and 2 unstaged patients. One patient had a tumor of low malignant potential, 4 patients had grade II tu mors, and 10 patients had tumors that were grade III. Eighty-three percent of patients had one or more preexisting medical illnesses, Cardiac disease, stroke, and hypertension were most common. Sixteen of 18 patients (88%) un derwent primary debulking surgery. American Society of Anesthesiologists ph ysical status classification was as follows: 7/16 (44%) class II, 6/16 (38% ) class III, and 2/16 (13%) class IV. The procedures performed included 16 bilateral salpingo-oophorectomies, 11 total abdominal hysterectomies, 16 om entectomies, 3 lymph node dissections, and 7 bowel resections. Four (25%) p atients were optimally cytoreduced to <1 cm of residual disease. Seventy-fi ve percent of surgical patients received blood transfusions of 2 or more un its PRBC, Mean EEL was 600 cc (range 200-4200 cc). Thirty-eight percent of patients experienced major postoperative morbidity. There were 7 patients w ith postoperative congestive heart failure, 3 with sepsis, 1 with aspiratio n pneumonia, and 2 postoperative deaths, Seventy-five percent of patients s pent time in the intensive care unit. Median number of days was 3 (range 1- 22 days), Mean postoperative stay was 8 days (range 6-57 days). Sixty-five percent of patients were discharged to home. The other patients were discha rged to intermediate care facilities or nursing homes. Eighty-three percent of patients received chemotherapy. Of the 10 patients (63%) receiving adju vant chemotherapy, the mean interval from surgery to initiation of therapy was 3 weeks (range 1-4 weeks). Overall median survival was 6 months (range 1-45 months). Median survival in patients with optimal debulking was 32.5 m onths (range 7-45 months) compared to 3.5 months (range 1-41 months) in pat ients suboptimally debulked. Conclusions. In patients older than 80 years of age who undergo debulking s urgery for ovarian cancer, serious medical comorbidity and advanced ASA sta tus are common. Despite aggressive surgical effort and frequent blood trans fusions, optimal debulking to less than 1 cm is achieved in only 25% of pat ients. Impressive morbidity and mortality occurs in this group of patients, but most patients are discharged to home and are able to receive postopera tive chemotherapy. (C) 1999 Academic Press.