Introduction/Background Patients over 75 with high grade ovarian cancer have poorer prognosis compared to younger patients due to decreased physiologic reserves, delayed diagnosis, and undertreatment due to fear of toxicity. We performed a hypothesis generating evaluation of outcomes following neoadjuvant chemotherapy compared to primary debulking surgery in patients over 75 with high grade ovarian cancer.
Methodology This is a retrospective cohort study of consecutive patients 75 years and above, with high grade stage III-IV ovarian cancer. Patients with inadequate follow-up were excluded. Descriptive statistics were performed to characterize groups based on primary treatment modality. Kaplan Meier survival curves were used to estimate overall and progression free survival with log rank tests for significance. Cox proportional hazards was performed for analysis of confounders.
Results Among 429 patients with stages III-IV high grade ovarian cancer (endometrioid and serous), 55 were over 75 years old and met inclusion criteria; 42 were treated with neoadjuvant chemotherapy followed by interval debulking compared to 13 patients undergoing primary debulking. There was no significant difference in demographic parameters. More patients were optimally debulked following neoadjuvant chemotherapy (50% vs 23%, p=0.003) and had a shorter length of stay (5 vs 7 days, p=0.018). Overall survival (mean 67.3 vs 59.7 months, p=0.765), and progression free survival (31.1 vs 47.1 months, p=0.143) were similar in patients treated with neoadjuvant chemotherapy compared to primary debulking.
Conclusion In this limited number of older patients with Stage III-IV high grade ovarian cancers, there was no significant difference in survival between those treated with neoadjuvant chemotherapy and primary debulking surgery.
Disclosure Nothing to disclose
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