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2016 | 14 | 4 | 212–221
Article title

Znaczenie neoadiuwantowej chemioterapii w leczeniu zaawansowanego raka jajnika u chorych geriatrycznych

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Title variants
EN
The role of neoadjuvant chemotherapy in the management of advanced ovarian cancer ingeriatric patients
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EN PL
Abstracts
EN
It is increasingly common for ovarian cancer to affect older women, with over half of all cases involving patients aged 65 years and older. Unfortunately, elderly patients with ovarian malignancy tend to be treated less aggressively than younger patients, with less extensive surgery and less intensive chemotherapy regimens. This is due to a variety of factors, such as overall medical fitness and the function of specific organs. Moreover, multiple morbidities are typical for geriatric patients and affect their eligibility for certain forms of cancer therapy as well as their treatment outcomes, which are commonly less satisfactory than in younger patients. Additionally, for fear of complications, treating physicians sometimes limit the extent of the necessary surgery, or adjust chemotherapy doses, even though such a course of management tends to be largely misguided. One available management option is neoadjuvant chemotherapy followed by a surgical treatment known as interval debulking surgery. This type of combination therapy is associated with fewer postoperative complications, thus increasing the patient’s chances of receiving a full course of adjuvant treatment. The decision to begin treatment with neoadjuvant chemotherapy tends to restrict later surgical therapy; however, under certain circumstances, this therapy can be a valid therapeutic option and, in fact, facilitate surgery. Prior to initiating therapy in elderly patients, their eligibility for combination therapy must be evaluated and the geriatric assessment of their performance and condition must be considered during the course of interdisciplinary preoperative management.
PL
Rak jajnika coraz częściej dotyka kobiety starsze, a ponad połowa zachorowań występuje u pacjentek w wieku powyżej 65 lat. Niestety starsze chore z rozpoznaniem raka jajnika częściej otrzymują mniej agresywne leczenie onkologiczne niż chore młodsze – mowa tu nie tylko o ograniczeniu zakresu zabiegów chirurgicznych, lecz także o mniej intensywnej chemioterapii. Wynika to z wielu czynników, takich jak stopień sprawności i wydolności poszczególnych narządów oraz często znaczna liczba schorzeń współistniejących. Wielochorobowość jest typowa dla osób w podeszłym wieku, co wpływa na kwalifikację do leczenia onkologicznego i na jego wyniki w tej grupie chorych. Wyniki terapii raka jajnika u pacjentek geriatrycznych są jeszcze bardziej niezadowalające niż u pacjentek młodszych. Ograniczenie leczenia chirurgicznego, opóźnienie kolejnych cykli lub redukcja dawek chemioterapii nierzadko są nieuzasadnione i wynikają z obawy przed wystąpieniem powikłań. Opcją postępowania może być wdrożenie w tej grupie chemioterapii neoadiuwantowej z następowym zabiegiem operacyjnym. Ten rodzaj leczenia skojarzonego jest związany z  mniejszą liczbą powikłań pooperacyjnych, co może zwiększać prawdopodobieństwo otrzymania pełnego leczenia adiuwantowego. Decyzja o rozpoczęciu postępowania od chemioterapii neoadiuwantowej niejako przesądza również o ograniczeniu zakresu późniejszego zabiegu chirurgicznego, ale w pewnych okolicznościach można ten fakt wykorzystać w planie terapeutycznym i dzięki chemioterapii neoadiuwantowej umożliwić leczenie chirurgiczne. Rozpoczynając terapię u osób starszych, należy uwzględnić ocenę geriatryczną ich stanu zdrowia w procesie interdyscyplinarnej kwalifikacji do leczenia skojarzonego.
Discipline
Year
Volume
14
Issue
4
Pages
212–221
Physical description
Contributors
  • Oddział Kliniczny Onkologii, Szpital Uniwersytecki, Kraków, Polska
  • Oddział Kliniczny Onkologii, Szpital Uniwersytecki, Kraków, Polska; Katedra i Klinika Onkologii, Uniwersytet Jagielloński – Collegium Medicum, Kraków, Polska
  • ddział Chemioterapii, Centrum Onkologii im. prof. Franciszka Łukaszczyka, Bydgoszcz, Polska; Katedra i Klinika Onkologii, Radioterapii i Ginekologii Onkologicznej, Collegium Medicum, Uniwersytet Mikołaja Kopernika w Toruniu, Bydgoszcz, Polska
  • Katedra i Klinika Onkologii, Radioterapii i Ginekologii Onkologicznej, Collegium Medicum, Uniwersytet Mikołaja Kopernika w Toruniu, Bydgoszcz, Polska
  • Katedra i Klinika Onkologii, Radioterapii i Ginekologii Onkologicznej, Collegium Medicum, Uniwersytet Mikołaja Kopernika w Toruniu, Bydgoszcz, Polska
  • Katedra i Klinika Onkologii, Radioterapii i Ginekologii Onkologicznej, Collegium Medicum, Uniwersytet Mikołaja Kopernika w Toruniu, Bydgoszcz, Polska
author
  • Oddział Kliniczny Onkologii, Szpital Uniwersytecki, Kraków, Polska; Katedra i Klinika Onkologii, Uniwersytet Jagielloński – Collegium Medicum, Kraków, Polska
  • Oddział Kliniczny Onkologii, Szpital Uniwersytecki, Kraków, Polska; Katedra i Klinika Onkologii, Uniwersytet Jagielloński – Collegium Medicum, Kraków, Polska
  • Katedra i Klinika Onkologii, Radioterapii i Ginekologii Onkologicznej, Collegium Medicum, Uniwersytet Mikołaja Kopernika w Toruniu, Bydgoszcz, Polska
References
  • 1. SEER Stat Fact Sheets: Ovarian Cancer. Available from: http:// seer.cancer.gov/statfacts/html/ovary.html.
  • 2. Krajowy Rejestr Nowotworów. Jajnik (C56). Available from: http://onkologia.org.pl/nowotwory-jajnika-c56.
  • 3. Dumas L, Ring A, Butler J et al.: Improving outcomes for older women with gynaecological malignancies. Cancer Treat Rev 2016; 50: 99–108.
  • 4. Joseph N, Clark RM, Dizon DS et al.: Delay in chemotherapy administration impacts survival in elderly patients with epithelial ovarian cancer. Gynecol Oncol 2015; 137: 401–405.
  • 5. Kurtz JE, Kaminsky MC, Floquet A et al.; Gynecologic Cancer Intergroup: Ovarian cancer in elderly patients: carboplatin and pegylated liposomal doxorubicin versus carboplatin and paclitaxel in late relapse: a Gynecologic Cancer Intergroup (GCIG) CALYPSO sub-study. Ann Oncol 2011; 22: 2417–2423.
  • 6. du Bois A, Reuss A, Pujade-Lauraine E et al.: Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO). Cancer 2009; 115: 1234–1244.
  • 7. Chang SJ, Bristow RE, Chi DS et al.: Role of aggressive surgical cytoreduction in advanced ovarian cancer. J Gynecol Oncol 2015; 26: 336–342.
  • 8. Bristow RE, Chang J, Ziogas A et al.: Impact of National Cancer Institute Comprehensive Cancer Centers on ovarian cancer treatment and survival. J Am Coll Surg 2015; 220: 940–950.
  • 9. Aletti GD, Eisenhauer EL, Santillan A et al.: Identification of patient groups at highest risk from traditional approach to ovarian cancer treatment. Gynecol Oncol 2011; 120: 23–28.
  • 10. Lee CK, Lord S, Grunewald T et al.: Impact of secondary cytoreductive surgery on survival in patients with platinum sensitive recurrent ovarian cancer: analysis of the CALYPSO trial. Gynecol Oncol 2015; 136: 18–24.
  • 11. Lee CK, Simes RJ, Brown C et al.: A prognostic nomogram to predict overall survival in patients with platinum-sensitive recurrent ovarian cancer. Ann Oncol 2013; 24: 937–943.
  • 12. Lee CK, Simes RJ, Brown C et al.: Prognostic nomogram to predict progression-free survival in patients with platinum-sensitive recurrent ovarian cancer. Br J Cancer 2011; 105: 1144–1150.
  • 13. Harter P, du Bois A, Hahmann M et al.; Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Committee; AGO Ovarian Cancer Study Group: Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial. Ann Surg Oncol 2006; 13: 1702–1710.
  • 14. Harter P, Sehouli J, Reuss A et al.: Prospective validation study of a predictive score for operability of recurrent ovarian cancer: the Multicenter Intergroup Study DESKTOP II. A project of the AGO Kommission OVAR, AGO Study Group, NOGGO, AGOAustria, and MITO. Int J Gynecol Cancer 2011; 21: 289–295.
  • 15. Tian WJ, Chi DS, Sehouli J et al.: A risk model for secondary cytoreductive surgery in recurrent ovarian cancer: an evidencebased proposal for patient selection. Ann Surg Oncol 2012; 19: 597–604.
  • 16. Delotte J, Arias T, Guerin O et al.: Hyperthermic intraperitoneal chemotherapy for the treatment of recurrent ovarian cancer in elderly women. Acta Obstet Gynecol Scand 2015; 94: 435–439.
  • 17. Zeng LJ, Xiang CL, Gong YZ et al.: Neoadjuvant chemotherapy for patients with advanced epithelial ovarian cancer: a metaanalysis. Sci Rep 2016; 6: 35914.
  • 18. Bristow RE, Eisenhauer EL, Santillan A et al.: Delaying the primary surgical effort for advanced ovarian cancer: a systematic review of neoadjuvant chemotherapy and interval cytoreduction. Gynecol Oncol 2007; 104: 480–490.
  • 19. Vergote I, Tropé CG, Amant F et al.: Neoadjuvant chemotherapy is the better treatment option in some patients with stage IIIc to IV ovarian cancer. J Clin Oncol 2011; 29: 4076–4078.
  • 20. Vergote I, Tropé CG, Amant F et al.; European Organization for Research and Treatment of Cancer-Gynaecological Cancer Group; NCIC Clinical Trials Group: Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 2010; 363: 943–953.
  • 21. Colombo PE, Mourregot A, Fabbro M et al.: Aggressive surgical strategies in advanced ovarian cancer: a monocentric study of 203 stage IIIC and IV patients. Eur J Surg Oncol 2009; 35: 135–143.
  • 22. Chang SJ, Bristow RE, Ryu HS: Prognostic significance of systematic lymphadenectomy as part of primary debulking surgery in patients with advanced ovarian cancer. Gynecol Oncol 2012; 126: 381–386.
  • 23. Aletti GD, Gostout BS, Podratz KC et al.: Ovarian cancer surgical resectability: relative impact of disease, patient status, and surgeon. Gynecol Oncol 2006; 100: 33–37.
  • 24. Chi DS, Bristow RE, Armstrong DK et al.: Is the easier way ever the better way? J Clin Oncol 2011; 29: 4073–4075.
  • 25. Aletti GD, Bristow RE, Chi D et al.: There is nothing new under the sun. J Clin Oncol 2015; 33: 3520.
  • 26. Kehoe S, Hook J, Nankivell M et al.: Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, noninferiority trial. Lancet 2015; 386: 249–257.
  • 27. Rose PG, Nerenstone S, Brady MF et al.; Gynecologic Oncology Group: Secondary surgical cytoreduction for advanced ovarian carcinoma. N Engl J Med 2004; 351: 2489–2497.
  • 28. van der Burg ME, van Lent M, Buyse M et al.: The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. Gynecological Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer. N Engl J Med 1995; 332: 629–634.
  • 29. Sabatier R, Calderon B Jr, Lambaudie E et al.: Prognostic factors for ovarian epithelial cancer in the elderly: a case-control study. Int J Gynecol Cancer 2015; 25: 815–822.
  • 30. Colombo PE, Labaki M, Fabbro M et al.: Impact of neoadjuvant chemotherapy cycles prior to interval surgery in patients with advanced epithelial ovarian cancer. Gynecol Oncol 2014; 135: 223–230.
  • 31. Aletti GD, Long HJ, Podratz KC et al.: Is time to chemotherapy a determinant of prognosis in advanced-stage ovarian cancer? Gynecol Oncol 2007; 104: 212–216.
  • 32. Hofstetter G, Concin N, Braicu I et al.: The time interval from surgery to start of chemotherapy significantly impacts prognosis in patients with advanced serous ovarian carcinoma – analysis of patient data in the prospective OVCAD study. Gynecol Oncol 2013; 131: 15–20.
  • 33. Alexander M, Beattie-Manning R, Blum R et al.: Guidelines for timely initiation of chemotherapy: a proposed framework for access to medical oncology and haematology cancer clinics and chemotherapy services. Intern Med J 2016; 46: 964–969.
  • 34. Hurria A, Togawa K, Mohile SG et al.: Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 2011; 29: 3457–3465.
  • 35. Kanesvaran R, Li H, Koo KN et al.: Analysis of prognostic factors of comprehensive geriatric assessment and development of a clinical scoring system in elderly Asian patients with cancer. JźClin Oncol 2011; 29: 3620–3627.
  • 36. Wildiers H, Heeren P, Puts M et al.: International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 2014; 32: 2595–2603.
  • 37. PACE participants; Audisio RA, Pope D, Ramesh HS et al.: Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study. Crit Rev Oncol Hematol 2008; 65: 156–163.
  • 38. Pope D, Ramesh H, Gennari R et al.: Pre-Operative Assessment of Cancer in the Elderly (PACE): a comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery. Surg Oncol 2006; 15: 189–197.
  • 39. Suidan RS, Leitao MM Jr, Zivanovic O et al.: Predictive value of the Age-Adjusted Charlson Comorbidity Index on perioperative complications and survival in patients undergoing primary debulking surgery for advanced epithelial ovarian cancer. Gynecol Oncol 2015; 138: 246–251.
Document Type
article
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YADDA identifier
bwmeta1.element.psjd-ce236686-388f-4f3f-89b3-0377577e023a
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