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Outcomes for Elderly Ovarian Cancer Patients Treated with Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC)

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Women 65 years of age or older with epithelial ovarian cancer (EOC) are thought to have a worse prognosis than younger patients. However, no consensus exists concerning the best treatment for ovarian cancer in this age group. This report presents outcomes for patients treated with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods

A prospective database of EOC patients treated with CRS/HIPEC (1998–2019) was analyzed. Perioperative variables were compared by treatment including upfront CRS/HIPEC, neoadjuvant chemotherapy plus CRS/HIPEC (NACT + CRS/HIPEC), and salvage CRS/HIPEC, and by age at surgery (< 65 and ≥ 65 years). Survival analysis was performed, and outcomes were compared.

Results

Of the 148 patients identified, 42 received upfront CRS/HIPEC, 48 received NACT + CRS/HIPEC, and 58 received salvage CRS/HIPEC. Each group was subdivided by age groups (< 65 and ≥ 65 years). The median overall survival (OS) after the upfront CRS/HIPEC was 69.2 months for the patients < 65 years of age versus 69.3 months for those ≥ 65 years of age. The OS after NACT + CRS/HIPEC was 26.9 months for the patients < 65 years of age versus 32.9 months for those ≥ 65 years of age, and the OS after salvage CRS/HIPEC was 45.6 months for the patients < 65 years of age versus 23.9 months for those ≥ 65 years of age. The median progression-free survival (PFS) after upfront CRS/HIPEC was 41.3 months for the patients < 65 years of age versus 45.4 months for those ≥ 65 years of age. The PFS after NACT + CRS/HIPEC was 16.2 months for the patients < 65 years of age versus 11.2 months for those ≥ 65 years of age, and the PFS after salvage CRS/HIPEC was 18.7 months for the patients < 65 years of age versus 10 months for those ≥ 65 years of age. The median follow-up period for the entire cohort was 44.6 months [95% confidence interval (CI) 34.7–60.6 months].

Conclusion

Age and feasibility of complete cytoreduction should be considered when treatment methods are selected for elderly patients. A carefully selected elderly population can benefit significantly from aggressive treatment methods.

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References

  1. Bouchardy C, Rapiti E, Blagojevic S, Vlastos AT, Vlastos G. Older female cancer patients: importance, causes, and consequences of undertreatment. J Clin Oncol. 2007;25:1858–69.

    Article  Google Scholar 

  2. Obeid NM, Azuh O, Reddy S, et al. Predictors of critical care-related complications in colectomy patients using the National Surgical Quality Improvement Program: exploring frailty and aggressive laparoscopic approaches. J Trauma Acute Care Surg. 2012;72:878–83.

    Article  Google Scholar 

  3. Bureau USC. Older People Projected to Outnumber Children for First Time in U.S History. Retrieved xxxx at https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html. 2019;CB18-41. Accessed 18 Sept 2019.

  4. Jorgensen TL, Teiblum S, Paludan M, et al. Significance of age and comorbidity on treatment modality, treatment adherence, and prognosis in elderly ovarian cancer patients. Gynecol Oncol. 2012;127:367–74.

    Article  Google Scholar 

  5. du Bois A, Quinn M, Thigpen T, et al. 2004 consensus statements on the management of ovarian cancer: final document of the 3rd International Gynecologic Cancer Intergroup Ovarian Cancer Consensus Conference (GCIG OCCC 2004). Ann Oncol. 2005;16(Suppl 8):viii7–12.

  6. Tewari D, Java JJ, Salani R, et al. Long-term survival advantage and prognostic factors associated with intraperitoneal chemotherapy treatment in advanced ovarian cancer: a gynecologic oncology group study. J Clin Oncol. 2015;33:1460–6.

    Article  CAS  Google Scholar 

  7. Mendivil AA, Rettenmaier MA, Abaid LN, et al. Consolidation hyperthermic intraperitoneal chemotherapy for the treatment of advanced stage ovarian carcinoma: a 3 year experience. Cancer Chemother Pharmacol. 2017;80:405–10.

    Article  CAS  Google Scholar 

  8. van Driel WJ, Koole SN, Sikorska K, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med. 2018;378:230–40.

    Article  Google Scholar 

  9. Spiliotis J, Halkia E, Lianos E, et al. Cytoreductive surgery and HIPEC in recurrent epithelial ovarian cancer: a prospective randomized phase III study. Ann Surg Oncol. 2015;22:1570–5.

    Article  CAS  Google Scholar 

  10. Shankar S, Ledakis P, El Halabi H, Gushchin V, Sardi A. Neoplasms of the appendix: current treatment guidelines. Hematol Oncol Clin N Am. 2012;26:1261–90.

    Article  Google Scholar 

  11. Aydin N, Sardi A, Milovanov V, et al. Outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma: experience of a peritoneal surface malignancy center. Am Surg. 2015;81:1253–9.

    Article  Google Scholar 

  12. Neuwirth MG, Alexander HR, Karakousis GC. Then and now: cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), a historical perspective. J Gastrointest Oncol. 2016;7:18–28.

    PubMed  PubMed Central  Google Scholar 

  13. Organization WH. A Global Course for Healthy Ageing. https://www.who.int/ageing/features/global-course/en/. 2015. Accessed 18 Sept 2019.

  14. Stathopoulos GP, Papadimitriou C, Aravantinos G, et al. Maintenance chemotherapy or not in ovarian cancer stages IIIA, B, C, and IV after disease recurrence. JBUON: J. Balk. Union Oncol. 2012;17:735–9.

    CAS  Google Scholar 

  15. Armstrong DK, Alvarez RD, Bakkum-Gamez JN, et al. NCCN Guidelines Insights: Ovarian Cancer, Version 1.2019. JNCCN J Natl Comp Cancer Network. 2019;17:896–909.

  16. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  Google Scholar 

  17. Alphs HH, Zahurak ML, Bristow RE, Diaz-Montes TP. Predictors of surgical outcome and survival among elderly women diagnosed with ovarian and primary peritoneal cancer. Gynecol Oncol. 2006;103:1048–53.

    Article  Google Scholar 

  18. Tortorella L, Vizzielli G, Fusco D, et al. Ovarian cancer management in the oldest old: improving outcomes and tailoring treatments. Aging Dis. 2017;8:677–84.

    Article  Google Scholar 

  19. Extermann M, Overcash J, Lyman GH, Parr J, Balducci L. Comorbidity and functional status are independent in older cancer patients. J Clin Oncol. 1998;16:1582–7.

    Article  CAS  Google Scholar 

  20. Li D, Soto-Perez-de-Celis E, Hurria A. Geriatric assessment and tools for predicting treatment toxicity in older adults with cancer. Cancer J Sudbury Mass. 2017;23:206–10.

    Google Scholar 

  21. Soto-Perez-de-Celis E, Li D, Yuan Y, Lau YM, Hurria A. Functional versus chronological age: geriatric assessments to guide decision-making in older patients with cancer. Lancet Oncol. 2018;19:e305–16.

    Article  Google Scholar 

  22. Halkia E, Spiliotis J, Sugarbaker P. Diagnosis and management of peritoneal metastases from ovarian cancer. Gastroenterol Res Pract. 2012;2012:541842.

    Article  Google Scholar 

  23. Deraco M, Kusamura S, Virzi S, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy as upfront therapy for advanced epithelial ovarian cancer: multi-institutional phase-II trial. Gynecol Oncol. 2011;122:215–20.

    Article  Google Scholar 

  24. Jimenez W, Sardi A, Nieroda C, et al. Predictive and prognostic survival factors in peritoneal carcinomatosis from appendiceal cancer after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2014;21:4218–25.

    Article  Google Scholar 

  25. Sardi A, Munoz-Zuluaga CA, Sittig M, Diaz-Montes T. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in seven patients with peritoneal sarcomatosis from uterine sarcoma. Clin Case Rep. 2018;6:1142–52.

    Article  Google Scholar 

  26. Sardi A, Sipok A, Baratti D, et al. Multi-institutional study of peritoneal sarcomatosis from uterine sarcoma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol. 2017;43:2170–7.

    Article  Google Scholar 

  27. Sipok A, Sardi A, Nieroda C, King MC, Sittig M, Gushchin V. Comparison of survival in patients with isolated peritoneal carcinomatosis from colorectal cancer treated with cytoreduction and melphalan or mitomycin-c as hyperthermic intraperitoneal chemotherapy agent. Int J Surg Oncol. 2018;2018:1920276.

    PubMed  PubMed Central  Google Scholar 

  28. Yao T, DeJong SR, McGree ME, Weaver AL, Cliby WA, Kumar A. Frailty in ovarian cancer identified the need for increased postoperative care requirements following cytoreductive surgery. Gynecol Oncol. 2019;153:68–73.

    Article  Google Scholar 

  29. Kumar A, Langstraat CL, DeJong SR, et al. Functional not chronologic age: frailty index predicts outcomes in advanced ovarian cancer. Gynecol Oncol. 2017;147:104–9.

    Article  Google Scholar 

  30. Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009;7:357–63.

    Article  Google Scholar 

  31. Williams GR, Mackenzie A, Magnuson A, et al. Comorbidity in older adults with cancer. J Geriatr Oncol. 2016;7:249–57.

    Article  Google Scholar 

  32. Sun V, Burhenn PS, Lai L, Hurria A. The impact of comorbidity on surgical outcomes in older adults with cancer. Semin Oncol Nurs. 2017;33:80–6.

    Article  Google Scholar 

  33. Chicago Consensus Working Group. The Chicago Consensus on peritoneal surface malignancies: standards. Cancer 2020;126:2516–24. https://doi.org/10.1002/cncr.32825.

    Article  Google Scholar 

  34. Paredes AZ, Abdel-Misih S, Schmidt C, Dillhoff ME, Pawlik TM, Cloyd JM. Predictors of readmission after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Surg Res. 2019;234:103–9.

    Article  Google Scholar 

  35. Votanopoulos KI, Shen P, Stewart JH, Levine EA. Outcomes of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients older than 70 years: survival benefit at considerable morbidity and mortality: a reply. Ann Surg Oncol. 2017;24(Suppl 3):602.

    Article  Google Scholar 

  36. McLean KA, Shah CA, Thompson SA, Gray HJ, Swensen RE, Goff BA. Ovarian cancer in the elderly: outcomes with neoadjuvant chemotherapy or primary cytoreduction. Gynecol Oncol. 2010;118:43–6.

    Article  Google Scholar 

  37. Warschkow R, Tarantino I, Lange J, et al. Does hyperthermic intraoperative chemotherapy lead to improved outcomes in patients with ovarian cancer? A single center cohort study in 111 consecutive patients. Patient Saf Surg. 2012;6:12.

    Article  Google Scholar 

  38. Chang SJ, Bristow RE. Evolution of surgical treatment paradigms for advanced-stage ovarian cancer: redefining ‘optimal’ residual disease. Gynecol Oncol. 2012;125:483–92.

    Article  Google Scholar 

  39. Cioffi R, Bergamini A, Rabaiotti E, et al. Neoadjuvant chemotherapy in high-risk ovarian cancer patients: role of age. Tumori. 2019;105:168–73.

    Article  Google Scholar 

  40. Elies A, Riviere S, Pouget N, et al. The role of neoadjuvant chemotherapy in ovarian cancer. Expert Rev Anticancer Ther. 2018;18:555–66.

    Article  CAS  Google Scholar 

  41. Armbruster S, Coleman RL, Rauh-Hain JA. Management and treatment of recurrent epithelial ovarian cancer. Hematol Oncol Clin N Am. 2018;32:965–82.

    Article  Google Scholar 

  42. Corrado G, Salutari V, Palluzzi E, Distefano MG, Scambia G, Ferrandina G. Optimizing treatment in recurrent epithelial ovarian cancer. Expert Rev Anticancer Ther. 2017;17:1147–58.

    Article  CAS  Google Scholar 

  43. Sun JH, Ji ZH, Yu Y, et al. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy to treat advanced/recurrent epithelial ovarian cancer: results from a retrospective study on prospectively established database. Translat Oncol. 2016;9:130–8.

    Article  Google Scholar 

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Acknowledgments

The authors would like to thank Ryan MacDonald, Ph.D. (Mercy Medical Center) for statistical analysis and contributions and Mary Caitlin King (Mercy Medical Center) for data review and extraction.

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Authors and Affiliations

  1. Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA

    Katherin Zambrano-Vera MD, Armando Sardi MD, FACS, Felipe Lopez-Ramirez MD, Michelle Sittig RN, Carlos Munoz-Zuluaga MD, Carol Nieroda MD, Vadim Gushchin MD, FACS & Teresa Diaz-Montes MD, MPh, FACOG

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  1. Katherin Zambrano-Vera MD
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  2. Armando Sardi MD, FACS
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  3. Felipe Lopez-Ramirez MD
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  5. Carlos Munoz-Zuluaga MD
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  7. Vadim Gushchin MD, FACS
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  8. Teresa Diaz-Montes MD, MPh, FACOG
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Correspondence to Armando Sardi MD, FACS.

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Zambrano-Vera, K., Sardi, A., Lopez-Ramirez, F. et al. Outcomes for Elderly Ovarian Cancer Patients Treated with Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC). Ann Surg Oncol 28, 4655–4666 (2021). https://doi.org/10.1245/s10434-020-09415-4

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