Ovarian Cancer in the elderly
Despite demographics showing a higher incidence and mortality rates over age 70, ovarian cancer clinical trials have long restricted elderly cancer patient’s inclusion either on inclusion criteria or even age limit. Moreover, even elderly- specific studies have long shown a different reality compared to elderly people depicted in population-basedanalyses. This review explores available data and contradictions in conclusion to be driven both in surgical and chemotherapic managements. Based on geriatric assessment rare studies have depicted a highly heterogeneous population and reported some covariates of prognostic value. Finally, this article tries to draw future challenging questions and perspectives.
Malgré des données démographiquesmontrant une incidence plus haute et des taux de mortalité sur l'âge 70, les essais cliniques de cancer des ovaires ont longtemps limité l'inclusion du cancéreux âgé sur des critères d'inclusion ou même la limite d'âge. De plus, même des personnes âgées - des études spécifiques ont longtemps montré une réalité différente comparée aux personnes âgées dépeintes dans des analyses à base de population.Cet examen(revue) explore des données disponibles et des contradictions dans la conclusion à être conduit dans des gestions(directions) tant chirurgicales que chemotherapic. Basé sur l'évaluation gériatrique des études rares ont dépeint une population fortement hétérogène et ont annoncé un certain covariates de valeur pronostique. Finalement, cet article essaye de dessiner(tirer) l'avenir desquestions stimulantes et des perspectives.
During three last decades, management of advances ovarian cancer was largely improved through the succession of both an extensive debulking surgical step and adjuvant chemotherapy. This allowed to improve overall survival rates. The median exceeding currently 35 months in most published series. Nevertheless, reported overall survival ofelderly patients, in population-based studies or even in randomized trials, are far lower. These differences may be explained by frequent sub-optimal management for the first ones, but also by excessive toxicities, leading to dose limitations or treatment arrest. In this context, standard treatment feasibility needed to be explored in elderly-specific population and specific conclusions to be drawn. Anextensive effort has already be done, in order to explore both surgical and chemotherapic management in elderly populations. Nevertheless, highly various populations have been depicted, starting from age definition (from over 60 to over 70 and even 80). We will see that this led to different conclusions, hard to transcribe in real-life practice.
Ovarian cancer is theleading cause of death from gynaecological cancer in the Western World. Incidence and mortality increase with age, incidence peaking between 75 and 79 and a mortality between 80 and 84. About half of the cases appear in women over the age of 65 (3). Age has been long recognized as an independent prognostic factor for ovarian cancer (4, 5) and differences in survival rates even increased withtreatment management improvements.(6,8).
Advances stages, ie FIGO stages 3 or 4 (en romain), represent the majority of the cases in ovarian cancer and even more in the elderly population (9 10). This can be explained by an asymptomatic disease at early stages and a delay in paraclinic examinations. Histo-prognostic features of ovarian cancer in the elderly are generally worse than in their youngercounterparts: more advanced stages, mixed histology, less differentiated tumours.
Treatment strategies: From theory to real time practice.
Main improvements in the last five decades in ovarian cancer management can be summarized into a surgical step – seeking for the smaller tumour residue. – and development of platinum-based poly-chemotherapy. The current accepted standard of care for...
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