Cytoreduction and HIPEC after neoadjuvant chemotherapy in stage IIIC-IV ovarian cancer. Critical analysis in elderly patients

ObjectivesThe aim of our study was to evaluate postoperative morbidity and mortality, disease-free and overall survival in patients older than 75 years undergoing interval debulking after neoadjuvant chemotherapy and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC).Study designWere included a series of consecutive patients diagnosed with stages IIIC/IV ovarian carcinoma, intervened after neoadjuvant systemic chemotherapy (paclitaxel and carboplatin) between January 2008 and June 2013. After completion of cytoreduction HIPEC was administered using paclitaxel (60 mg/m2) or cisplatin (75 mg/m2). We analyzed and compared the results of postoperative morbidity and mortality, disease-free survival and overall survival in patients ≥75 years compared to patients with lower ages intervened in the same time period.ResultsFrom a total of 66 patients tested, 9 patients were ≥75 years (14%). Grade I-IV morbidity was significantly higher in patients ≥75 years (78% vs 35%, p <0.05) as well as grade III-IV disease (56% vs 16%, p <0.05). There were no procedure-related mortality. In patients ≥75 years the median disease-free survival was 6 months (95% CI: 3.5-8.5 months) vs 24 months (95% CI: 10.5-37.5 months) in younger patients. The median overall survival in patients ≥75 years was 13 months (95% CI: 4.7-21.3), not having reached at time of analysis of the database in younger patients.ConclusionsPatients ≥75 years received no benefit in prognosis after interval cytoreduction with HIPEC and paid a high price in terms of postoperative morbidity. This age group should be excluded from this therapeutic procedure.