Older Women With Ovarian Cancer May Benefit From More Aggressive Treatment

Healio
15 Jan, 2021 ,

Adopting an aggressive treatment strategy that comprises upfront cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy may be beneficial for certain older women with ovarian cancer. Researchers have found a long median overall survival of 69.2 months for women aged younger than 65 years and 69.3 months for those aged 65 years or older with upfront cytoreductive surgery plus HIPEC. The median progression-free survival was also found to be longer in women who underwent this treatment.

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Upfront cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy may be a viable treatment for certain older women with ovarian cancer, according to results of a study published in Annals of Surgical Oncology.

“There has been a constant debate among oncologists on how much treatment is too much,” Vadim Gushchin, MD, FACS, surgical oncologist and director of the hyperthermic intraperitoneal chemotherapy (HIPEC) program at Institute for Cancer Care at Mercy in Baltimore, told Healio. “Ovarian cancer frequently develops in older women. We often ask ourselves whether we should offer our older patients aggressive treatment modalities such as cytoreduction and HIPEC, whether the treatment is effective in these women and whether older women have more complications after these complex treatments. Our study suggests that the longevity of patients who underwent cytoreduction plus HIPEC for ovarian cancer was similar regardless of age, and older women were able to recover from this aggressive treatment well.”

No consensus exists on the best treatment methods for women aged 65 years or older with epithelial ovarian cancer.

Gushchin and colleagues sought to assess the outcomes of cytoreductive surgery plus HIPEC among women with epithelial ovarian cancer included in a prospective database between 1998 and 2019. They compared perioperative variables by treatment, including cytoreductive surgery plus HIPEC (n = 42), neoadjuvant chemotherapy plus cytoreductive surgery and HIPEC (n = 48) and salvage cytoreductive surgery plus HIPEC (n = 58), as well as by age at surgery (< 65 years and 65 years).

Median follow-up was 44.6 months.

Results showed the longest median OS among women treated with upfront cytoreductive surgery plus HIPEC — 69.2 months for those aged younger than 65 years and 69.3 months for those aged 65 years or older.

Median OS for women treated with neoadjuvant chemotherapy plus cytoreductive surgery and HIPEC was 26.9 months for those aged younger than 65 years vs. 32.9 months for those aged 65 years or older, and 45.6 months vs. 23.9 months for those treated with salvage cytoreductive surgery plus HIPEC.

Median PFS also was longer among women who received upfront cytoreductive surgery plus HIPEC — 41.3 months for those aged younger than 65 years vs. 45.4 months for those aged 65 years or older — compared with women who received neoadjuvant chemotherapy plus cytoreductive surgery and HIPEC (16.2 months vs. 11.2 months) or salvage cytoreductive surgery plus HIPEC (18.7 months vs. 10 months).

Researchers observed no deaths among those aged younger than 65 years compared with an overall 30-day mortality rate of 8.3% and 90-day mortality of 13.3% among those aged 65 years or older.

“Caring for elderly patients requires additional skills and resources,” Gushchin said. “We will continue our efforts to quantify these requirements to make our results are applicable across other institutions. Also, we are planning to investigate how age factors together with molecular prognostic factors of ovarian cancer. These data could allow us to select patients better for different treatments.”