Epithelial ovarian cancer and primary peritoneal carcinomatosis in the elderly: what is our clinical practice?

Purpose of investigation: The aim of this study was to evaluate clinical practice and the prognostic variables related to survival in elderly people diagnosed with epithelial ovarian cancer (EOC) or primary peritoneal carcinomatosis (PPC). Materials and Methods: Fifty-three patients were included and they were divided into two groups, 65-75 years and over 75 years. The variables analyzed were PS, CA125, stage, metastases, cytoreductive surgery, quality of surgery, chemotherapy, and response to chemotherapy. Results: The median age of the patients was 73 years. Eighty-nine of the patients had EOC. The median overall survival was 30.5 months with no significant difference between the age groups. The statistical analysis showed no difference except among Stage III patients compared to IV in favor of the younger group (p = 0.023). In the multivariate analysis only the Eastern Cooperative Oncology Group (ECOG) score (p = 0.001) and response to chemotherapy (p = 0.007) significantly influenced survival. Conclusion: The specific assessment of elderly allows optimizing the results of cancer treatment in ovarian tumors.

Epithelial ovarian cancer, Primary peritoneal carcinomatosis, Elderly patients, Geriatric assessment.

[1] Haddad A., Shepard D.: “Geriatric Oncology and Palliative Medicine”. Semin. Oncol., 2011, 38, 362.

[2] Petignat P., Fioretta G., Verkooijen H.M., Vlastos A.T., Rapiti E., Bouchardy C., Vlastos G.: “Poorer survival of elderly patients with ovarian cancer: a population-based study”. Surg. Oncol., 2004, 13, 181.

[3] Fairfield K.M., Lucas F.L., Earle C.C., Small L., Trimble E.L., Warren J.L.: “Regional variation in cancer-directed surgery and mortality among women with epithelial ovarian cancer in the Medicare population”. Cancer, 2010, 116, 4840.

[4] Winter W.E. 3rd, Maxwell G.L., Tian C., Carlson J.W., Ozols R.F., Rose P.G., et al.: “Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group Study”. J. Clin. Oncol., 2007, 25, 3621.

[5] Freyer G., Geay J.F., Touzet S., Provencal J., Weber B., Jacquin J.P., et al.: “Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study”. Ann. Oncol., 2005, 16, 1795.

[6] Bhuyan P., Mahapatra S., Mahapatra S., Sethy S., Parida P., Satpathy S.: “Extraovarian primary peritoneal papillary serous carcinoma”. Arch. Gynecol. Obstet., 2010, 281, 5561.

[7] Falandry C., Weber B., Savoye A.M., Tinquaut F., Tredan O., Sevin E., et al.: “Development of a geriatric vulnerability score in elderly patients with advanced ovarian cancer treated with first-line carboplatin: a GINECO prospective trial”. Ann. Oncol., 2013, 24, 2808.

[8] Mohile S.G., Magnuson A.: “Comprehensive geriatric assessment in oncology”. Interdiscip. Top. Gerontol., 2013, 38, 85.

[9] Brunello A., Sandri R., Extermann M.: “Multidimensional geriatric evaluation for older cancer patients as a clinical and research tool”. Cancer Treat. Rev., 2009, 35, 487.

[10] Carey M.S., Bacon M., Tu D., Butler L., Bezjak A., Stuart G.C.: “The prognostic effects of performance status and quality of life scores on progression-free survival and overall survival in advanced ovarian cancer”. Gynecol. Oncol., 2008, 108, 100.

[11] Owusu C., Koroukian S.M., Schluchter M., Bakaki P., Berger N.A.: “Screening older cancer patients for a Comprehensive Geriatric Assessment: A comparison of three instruments”. J Geriatr. Oncol., 2011, 2, 121.

[12] Extermann M., Hurria A.: “Comprehensive geriatric assessment for older patients with cancer”. J. Clin. Oncol., 2007, 25, 1824.

[13] Repetto L., Fratino L., Audisio R.A., Venturino A., Gianni W., Vercelli M., et al.: “Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study”. J. Clin. Oncol., 2002, 20, 494.

[14] Wildiers H., Heeren P., Puts M., Topinkova E., Janssen-Heijne M.L.G., Extermann M., et al. “International Society of Geriatric Oncology Consensus on Geriatric assessment in Older patients with cancer”. J. Clin. Oncol., 2014, 32, 2595.

[15] Puts M.T., Hardt J., Monette J., Girre V., Springal E., Alibhai S.M.H.: “Use of geriatric assessment for older adults in the oncology setting: a systematic review”. J. Natl. Cancer Inst., 2012, 104, 1133.

[16] Trillsch F., Woelber L., Eulenburg C., Braicu I., Lambrechts S., Chekerov R., et al.: “Treatment reality in elderly patients with advanced ovarian cancer: a prospective analysis of the OVCAD consortium”. J. Ovarian Res., 2013, 6, 42.

[17] Hilpert F., du Bois A., Greimel E.R., Hedderich J., Krause G., Venhoff L., et al.: “ Feasibility, toxicity and quality of life of first-line chemotherapy with platinum/paclitaxel in elderly patients aged > or = 70 years with advanced ovarian cancer - a study by the AGO OVAR Germany”. Ann. Oncol., 2007, 18, 282.

[18] Dale D.C.: “Poor prognosis in elderly patients with cancer: the role of bias and undertreatment”. J. Support Oncol., 2003, 1, 11.

[19] Ahmed A., Zamba G., De Geest K., Lynch C.F.: “The impact of surgery on survival of elderly women with endometrial cancer in the SEER program from 1992–2002”. Gynecol. Oncol., 2008, 111, 35.

[20] Decoster L., Van Puyvelde K., Mohile S., Wedding U., Basso U., Colloca G., et al.: “Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations†”. Ann. Oncol., 2015, 26, 288.

[21] Hurria A., Cohen H.J., Extermann M.: “Geriatric Oncology research in the cooperative groups: a report of a SIOG special meeting”. J. Geriatr. Oncol., 2010, 1, 40.

[22] Maione P., Perrone F., Gallo C., Manzione L., Piantedosi F., Barbera S., et al.: “Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study”. J. Clin. Oncol., 2005, 23, 6865.

[23] Caillet P., Canoui-Poitrine F., Vouriot J., Berle M., Reinald N., Krypciak S., et al.: “Comprehensive geriatric assessment in the decisionmaking process in elderly patients with cancer: ELCAPA study”. J. Clin. Oncol., 2011, 29, 3636.

[24] Caillet P., Laurent M., Bastuji-Garin S., Liuu E., Culine S., Lagrange J.L., et al. : “Optimal management of elderly cancer patients: usefulness of the Comprehensive Geriatric Assessment”. Clin. Interv. Aging, 2014, 9, 1645.

[25] Kenis C., Bron D., Libert Y., Decoster L., Van Puyvelde K., Scalliet P., et al.: “Relevance of a systematic geriatric screening and assessment in older patients with cancer: Results of a prospective multicentric study”. Ann. Oncol., 2013, 24, 1306.