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Aggressive Tx for Ovarian Ca in Elderly Doesn't Raise Morbidity


 

RANCHO MIRAGE, CALIF. — Aggressive surgery for epithelial ovarian cancer did not increase mortality or morbidity, compared with less aggressive surgery in patients over age 65 or with medical comorbidities, a review of 140 cases found.

Some surgeons are hesitant to pursue cytoreductive surgery in these kinds of patients as aggressively as they might in patients with fewer surgical risk factors because of previous data showing poorer survival rates in older women.

Federal data show that older patients with cancer are less likely to be treated surgically.

In the current study, only the amount of ovarian tumor removed was associated with survival, Sameer Sharma, M.D., said at the annual meeting of the Society of Gynecologic Surgeons.

Surgery reduced the tumor to less than 1 cm in diameter (considered “optimal debulking”) in 88% of patients. Patients with optimal debulking survived a median of 52 months, compared with 26 months for patients with more tumor left after surgery, said Dr. Sharma of the Roswell Park Cancer Institute, Buffalo, N.Y.

There appears to be no significant difference in survival based on age alone, which contradicts previous findings, Dr. Sharma reported.

There were no significant differences in survival or in the rate of complications during or after surgery among the 24% of patients who underwent standard debulking surgery, the 57% who had radical debulking surgery, or the 19% who underwent supraradical debulking surgery.

Patients with comorbid medical conditions tolerated the radical procedures without an increase in postoperative complications.

Older patients and those with comorbidities were just as likely to undergo extensive cytoreduction as less aggressive surgery.

Patients who underwent the more radical procedures, however, were more likely to need a blood transfusion, “which is probably due to underlying cardiovascular disease,” Dr. Sharma said.

Forty-five percent of patients were aged 65 years or older, and 49% of the total cohort had major medical comorbidity, most commonly cardiovascular disease.

A majority of patients had multiple surgical risk factors, such as advanced age plus medical comorbidities.

Despite this, “we were able to achieve highly respectable optimal cytoreductive rates, with 60% of patients having less than 0.5 cm of residual disease after surgery,” he added.

The study clearly shows that older women with ovarian cancer can tolerate aggressive surgery, which leads to better survival rates, Dr. Donald Gallup said in formal commentary that was given after Dr. Sharma's presentation.

“This study is important for those gynecologists who operate on the elderly with comorbidities, whether the patient has cancer or other female conditions that require major operative intervention,” said Dr. Gallup of Savannah, Ga.

The median age of patients in the study was 63 years. They remained hospitalized after surgery for a mean of 8 days, mainly for reasons related to bowel function, Dr. Sharma said.

Follow-up lasted a median of 30 months.

Overall, 24% of patients required transfusion within 30 days after surgery, and 18% had other postoperative complications, mostly problems related to infection or the ileus. Two patients required reoperation. There was one perioperative death in a patient with liver failure from multiple liver metastases.

Age and medical comorbidities should not preclude patients from receiving “maximal surgical effort. Optimal cytoreduction continues to be a critical factor in survival,” Dr. Sharma said.

In the United States, 48% of ovarian epithelial cancer is diagnosed in women older than 65 years. It is the leading cause of death from gynecologic cancers. In 2004, of the 26,000 U.S. women diagnosed, 16,000 will ultimately die of the disease, he said.

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