Localized ovarian cancer in the elderly: The gynecologic oncology group experience

Authors

  • Robert C. Young M.D.,

    Corresponding author
    1. Fox Chase Cancer Center, Philadelphia, Pennsylvania
    • GOG Administrative Office, Suite 1945, 1234 Market Street, Philadelphia, PA 19107
    Search for more papers by this author
  • Mark F. Brady B.S.,

    Corresponding author
    1. Roswell Park Cancer Institute, Buffalo, New York
    • GOG Administrative Office, Suite 1945, 1234 Market Street, Philadelphia, PA 19107
    Search for more papers by this author
  • Leslie A. Walton M.D.,

    Corresponding author
    1. Department of Obstetrics and Gynecology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina
    • GOG Administrative Office, Suite 1945, 1234 Market Street, Philadelphia, PA 19107
    Search for more papers by this author
  • Howard D. Homesley M.D.,

    Corresponding author
    1. Department of Obstetrics and Gynecology, and Section on Gynecologic Oncology, Comprehensive Cancer Center of Wake Forest University, Winston-Salem, North Carolina
    • GOG Administrative Office, Suite 1945, 1234 Market Street, Philadelphia, PA 19107
    Search for more papers by this author
  • Hervy E. Averette M.D.,

    Corresponding author
    1. Division of Gynecologic Oncology, Jackson Memorial Medical Center, University of Miami School of Medicine, Miami, Florida
    • GOG Administrative Office, Suite 1945, 1234 Market Street, Philadelphia, PA 19107
    Search for more papers by this author
  • Harry J. Long M.D.

    Corresponding author
    1. Division of Oncology, Mayo Comprehensive Cancer Center, Rochester, Minnesota
    • GOG Administrative Office, Suite 1945, 1234 Market Street, Philadelphia, PA 19107
    Search for more papers by this author

Abstract

Background. The appropriate therapy for patients with localized (FIGO Stage I and II) ovarian cancer has been poorly defined for all age groups and particularly for the elderly. Few prospective randomized comparisons of adjuvant therapy after careful surgical staging have been performed. The Gynecologic Oncology Group (GOG) has performed a series of trials testing adjuvant treatment in carefully staged patients with early-stage ovarian cancer. Early trials included few elderly patients but the most recent trial (GOG 95) included 18% over the age of 65 years.

Methods. Comprehensive surgical staging defined by protocol is performed before randomization. Patients with predefined stages and histologies are included and the patients are randomized prospectively to receive either intraperitoneal phosphorus-32 or three monthly cycles of cyclophosphamide and cisplatin. Assessment of the value of this adjuvant therapy will depend on survival, disease-free survival, and relapse pattern differences between the two adjuvant therapies.

Results. This is an ongoing clinical trial and insufficient numbers of patients have been randomized for definitive conclusions. There have been seven recurrences on both arms of the trial with a median time to recurrence of 14 months. There currently are no significant age differences between relapsed patients and disease-free patients. At this point, 12 elderly patients have been randomized to each of the arms of therapy.

Conclusions. Although no apparent survival differences exist for elderly patients in the most recent adjuvant chemotherapy trial of early ovarian cancer, the number of patients with cancer randomized and follow-up are insufficient to establish such a difference. Currently there is no evidence that elderly patients display a significant difference in relapse frequency or pattern.

Ancillary