Treatment of ovarian cancer in elderly women. Mayo Clinic-North Central Cancer Treatment Group studies.

BACKGROUND

With a 25% reduction in ovarian cancer mortality rate between 1973 and 1988 among younger American women, the overall control of ovarian cancer appeared to be improving. Unfortunately, American women older than 65 years of age experienced a 16% increase in mortality from this disease during that same interval. We examined our therapeutic outcomes following systemic chemotherapy administered to women of various ages accepted for treatment on phase III Mayo Clinic and North Central Cancer Treatment Group protocols between 1974 and 1988.

METHODS

Three randomized studies of chemotherapy for Stage III and IV epithelial ovarian carcinoma were analyzed for possible effects of age on the results of treatment. All of the patients, regardless of age, had been enrolled and treated according to standard accession and dosage adjustment criteria.

RESULTS

Among our 383 patients, 107 (28%) were 65 years of age or older. Although the elderly women tolerated our five different chemotherapy regimens nearly as well as did the younger patients, we found that progressively greater dose reductions were required for treatment continuation with advancing age between groups aged 44 years or younger, 45-64 years, and 65 years and older. When nonserous histology, Stage IV, ECOG performance status above 0, tumor grade above 1, and extent of residual disease greater than 2 cm were considered, our Cox model analysis yielded no firm evidence that age 65 years and older per se (P = 0.58) was a negative prognostic factor for survival.

CONCLUSIONS

Elderly women eligible for randomized clinical trials tolerated Stage III and IV epithelial ovarian carcinoma and its chemotherapy nearly as well as did younger women. Among this population of women accepted for study in our three clinical trials, age 65 years and older per se was not proven to be a negative prognostic factor in our multivariate analysis.