Advertisement

Management of endometrial, ovarian and cervical cancer in the elderly: current approach to a challenging condition

  • Salvatore Giovanni Vitale
  • Stella Capriglione
  • Gabriella Zito
  • Salvatore Lopez
  • Ferdinando Antonio Gulino
  • Federica Di Guardo
  • Amerigo Vitagliano
  • Marco Noventa
  • Valentina Lucia La Rosa
  • Fabrizio Sapia
  • Gaetano Valenti
  • Agnese Maria Chiara Rapisarda
  • Isabel Peterlunger
  • Diego Rossetti
  • Antonio Simone Laganà
Review

Abstract

Purpose

Gynaecological cancer management in older people represents a current challenge. Therefore, in the present paper, we aimed to gather all the evidence reported in the literature concerning gynecological cancers in the elderly, illustrating the state of art and the future perspectives.

Methods

We searched MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials, IBECS, BIOSIS, Web of Science, SCOPUS and Grey literature (Google Scholar; British Library) from January 1952 to May 2017, using the terms “ovarian cancer”, “endometrial cancer”, “cervical cancer”, “gynecological cancers” combined with ‘elderly’, ‘cancer’, ‘clinical trial’ and ‘geriatric assessment’.

Results

The search identified 81 citations, of which 65 were potentially relevant after initial evaluation and met the criteria for inclusion and were analyzed. We divided all included studies into three different issue: “Endometrial cancer”, “Ovarian cancer” and “Cervical cancer”.

Conclusions

The present literature review shows that, in spite of the higher burden of comorbidities, elderly patients can also benefit from standard treatment to manage their gynecological cancers. It is important to overcome the common habit of undertreating the elderly patients because they are more fragile and with a lower life expectancy than their younger counterpart. Further trials with elderly women are warranted.

Keywords

Gynaecological cancers Elderly Ovarian cancer Cervical cancer Endometrial cancer 

Notes

Author contributions

Substantial contributions to conception and design: Salvatore GV, SC, SL, FAG, ASL. Drafting and revising the artic1e critically for important intellectual content: GZ, AV, MN, VLR, FS, GV, AMCR. Final approval of the version to be published: IP, DR.

Funding

This work was not supported by any grant or other form of funding.

Compliance with ethical standards

Conflict of interest

The authors have no proprietary, financial, professional or other personal interest of any nature in any product, service or company. The authors alone are responsible for the content and writing of the paper.

References

  1. 1.
    Yancik R (2005) Population aging and cancer: a cross-national concern. Cancer J 11(6):437–441PubMedCrossRefGoogle Scholar
  2. 2.
    Yancik R (1997) Cancer burden in the aged: an epidemiologic and demographic overview. Cancer 80(7):1273–1283PubMedCrossRefGoogle Scholar
  3. 3.
    Pallis AG, Fortpied C, Wedding U, Van Nes MC, Penninckx B, Ring A, Lacombe D, Monfardini S, Scalliet P, Wildiers H (2010) EORTC elderly task force position paper: approach to the older cancer patient. Eur J Cancer 46(9):1502–1513PubMedCrossRefGoogle Scholar
  4. 4.
    Olson SH, De Vivo I, Setiawan VW, Lu KH (2015) Symposium on advances in endometrial cancer epidemiology and biology. Gynecol Oncol 138(3):497–500PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Cignini P, Vitale SG, Laganà AS, Biondi A, La Rosa VL, Cutillo G (2017) Preoperative work-up for definition of lymph node risk involvement in early stage endometrial cancer: 5-year follow-up. Updates Surg 69(1):75–82PubMedCrossRefGoogle Scholar
  6. 6.
    Rossetti D, Vitale SG, Gulino FA, Cignini P, Rapisarda AMC, Biondi A, Frigerio L (2016) Concomitant chemoradiation treatment in selected stage I endometrioid endometrial cancers. Eur J Gynaecol Oncol 37(5):657–661PubMedGoogle Scholar
  7. 7.
    Vitale SG, Valenti G, Gulino FA, Cignini P, Biondi A (2016) Surgical treatment of high stage endometrial cancer: current perspectives. Updates Surg 68(2):149–154PubMedCrossRefGoogle Scholar
  8. 8.
    Vitale SG, Laganà AS, Capriglione S, Angioli R, La Rosa VL, Lopez S, Valenti G, Sapia F, Sarpietro G, Butticè S, Tuscano C, Fanale D, Tropea A, Rossetti D (2017) Target therapies for uterine carcinosarcomas: current evidence and future perspectives. Int J Mol Sci.  https://doi.org/10.3390/ijms18051100 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    De Marzi P, Ottolina J, Mangili G, Rabaiotti E, Ferrari D, Viganò R, Candiani M (2013) Surgical treatment of elderly patients with endometrial cancer (≥ 65 years). J Geriatr Oncol. 4(4):368–373PubMedCrossRefGoogle Scholar
  10. 10.
    Susini T, Massi G, Amunni G, Carriero C, Marchionni M, Taddei G, Scarselli G (2005) Vaginal hysterectomy and abdominal hysterectomy for treatment of endometrial cancer in the elderly. Gynecol Oncol 96(2):362–367PubMedCrossRefGoogle Scholar
  11. 11.
    Lachance JA, Everett EN, Greer B, Mandel L, Swisher E, Tamimi H, Goff B (2006) The effect of age on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. Gynecol Oncol 101(3):470–475PubMedCrossRefGoogle Scholar
  12. 12.
    Vaknin Z, Ben-Ami I, Schneider D, Pansky M, Halperin R (2009) A comparison of perioperative morbidity, perioperative mortality, and disease-specific survival in elderly women (≥ 70 years) versus younger women (< 70 years) with endometrioid endometrial cancer. Int J Gynecol Cancer 19(5):879–883PubMedCrossRefGoogle Scholar
  13. 13.
    Siesto G, Uccella S, Ghezzi F, Cromi A, Zefiro F, Serati M, Bolis P (2010) Surgical and survival outcomes in older women with endometrial cancer treated by laparoscopy. Menopause 17(3):539–544PubMedGoogle Scholar
  14. 14.
    Scribner DR Jr, Walker JL, Johnson GA, McMeekin SD, Gold MA, Mannel RS (2001) Surgical management of early-stage endometrial cancer in the elderly: is laparoscopy feasible? Gynecol Oncol 83(3):563–568PubMedCrossRefGoogle Scholar
  15. 15.
    Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, Spiegel G, Barakat R, Pearl ML, Sharma SK (2009) Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol 27(32):5331–5336PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Ghezzi F, Cromi A, Siesto G, Serati M, Bogani G, Sturla D, Bolis P (2010) Use of laparoscopy in older women undergoing gynecologic procedures: is it time to overcome initial concerns? Menopause 17(1):96–103PubMedCrossRefGoogle Scholar
  17. 17.
    Frey MK, Ihnow SB, Worley MJ Jr, Heyman KP, Kessler R, Slomovitz BM, Holcomb KM (2011) Minimally invasive staging of endometrial cancer is feasible and safe in elderly women. J Minim Invasive Gynecol 18(2):200–204PubMedCrossRefGoogle Scholar
  18. 18.
    Bijen CB, de Bock GH, Vermeulen KM, Arts HJ, ter Brugge HG, van der Sijde R, Kraayenbrink AA, Bongers MY, van der Zee AG, Mourits MJ (2011) Laparoscopic hysterectomy is preferred over laparotomy in early endometrial cancer patients, however not cost effective in the very obese. Eur J Cancer 47(14):2158–2165PubMedCrossRefGoogle Scholar
  19. 19.
    Perrone AM, Di Marcoberardino B, Rossi M, Pozzati F, Pellegrini A, Procaccini M, Santini D, De Iaco P (2012) Laparoscopic versus laparotomic approach to endometrial cancer. Eur J Gynaecol Oncol 33(4):376–381PubMedGoogle Scholar
  20. 20.
    Bogani G, Cromi A, Uccella S, Serati M, Casarin J, Mariani A, Ghezzi F (2014) Laparoscopic staging in women older than 75 years with early-stage endometrial cancer: comparison with open surgical operation. Menopause 21(9):945–951PubMedCrossRefGoogle Scholar
  21. 21.
    Zeng XZ, Lavoue V, Lau S, Press JZ, Abitbol J, Gotlieb R, How J, Wang Y, Gotlieb WH (2015) Outcome of robotic surgery for endometrial cancer as a function of patient age. Int J Gynecol Cancer 25(4):637–644PubMedCrossRefGoogle Scholar
  22. 22.
    Vaknin Z, Perri T, Lau S, Deland C, Drummond N, Rosberger Z, Gourdji I, Gotlieb WH (2010) Outcome and quality of life in a prospective cohort of the first 100 robotic surgeries for endometrial cancer, with focus on elderly patients. Int J Gynecol Cancer 20(8):1367–1373PubMedGoogle Scholar
  23. 23.
    Lowe MP, Kumar S, Johnson PR, Kamelle SA, Chamberlain DH, Tillmanns TD (2010) Robotic surgical management of endometrial cancer in octogenarians and nonagenarians: analysis of perioperative outcomes and review of the literature. J Robot Surg 4(2):109–115PubMedCrossRefGoogle Scholar
  24. 24.
    Lavoue V, Zeng X, Lau S, Press JZ, Abitbol J, Gotlieb R, How J, Wang Y, Gotlieb WH (2014) Impact of robotics on the outcome of elderly patients with endometrial cancer. Gynecol Oncol 133(3):556–562PubMedCrossRefGoogle Scholar
  25. 25.
    Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Hauspy J, Jimenez W, Rosen B, Gotlieb WH, Fung-Kee-Fung M, Plante M (2010) Laparoscopic surgery for endometrial cancer: a review. J Obstet Gynaecol Can 32(6):570–579PubMedCrossRefGoogle Scholar
  27. 27.
    Holloway RW, Ahmad S, DeNardis SA, Peterson LB, Sultana N, Bigsby GE 4th, Pikaart DP, Finkler NJ (2009) Robotic-assisted laparoscopic hysterectomy and lymphadenectomy for endometrial cancer: analysis of surgical performance. Gynecol Oncol 115(3):447–452PubMedCrossRefGoogle Scholar
  28. 28.
    Revenig LM, Canter DJ, Taylor MD, Tai C, Sweeney JF, Sarmiento JM, Kooby DA, Maithel SK, Master VA, Ogan K (2013) Too frail for surgery? Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes. J Am Coll Surg 217(4):665–670.e1PubMedCrossRefGoogle Scholar
  29. 29.
    Giannice R, Foti E, Poerio A, Marana E, Mancuso S, Scambia G (2004) Perioperative morbidity and mortality in elderly gynecological oncological patients (> 70 years) by the American society of anesthesiologists physical status classes. Ann Surg Oncol 11(2):219–225PubMedCrossRefGoogle Scholar
  30. 30.
    World Cancer Research Fund/American Institute for Cancer Research (2014) Continuous update project report. Food, nutrition, physical activity, and the prevention of ovarian cancer. http://www.dietandcancerreport.org/cup/cup_resources.php
  31. 31.
    Oberaigner W, Minicozzi P, Bielska-Lasota M, Allemani C, de Angelis R, Mangone L, Sant M, Eurocare Working Group (2012) Survival for ovarian cancer in Europe: the across-country variation did not shrink in the past decade. Acta Oncol 51(4):441–453PubMedCrossRefGoogle Scholar
  32. 32.
    Edwards BK, Howe HL, Ries LA, Thun MJ, Rosenberg HM, Yancik R, Wingo PA, Jemal A, Feigal EG (2002) Annual report to the nation on the status of cancer, 1973–1999, featuring implications of age and aging on U.S. cancer burden. Cancer 94(10):2766–2792PubMedCrossRefGoogle Scholar
  33. 33.
    Yancik R, Ries A (2004) Cancer in older persons: an international issue in an aging world. Semin Oncol 31(2):128–136PubMedCrossRefGoogle Scholar
  34. 34.
    Ries LA (1993) Ovarian cancer. Survival and treatment differences by age. Cancer 71(2 Suppl):524–529PubMedPubMedCentralGoogle Scholar
  35. 35.
    Bellia A, Vitale SG, Laganà AS, Cannone F, Houvenaeghel G, Rua S, Ladaique A, Jauffret C, Ettore G, Lambaudie E (2016) Feasibility and surgical outcomes of conventional and robot-assisted laparoscopy for early-stage ovarian cancer: a retrospective, multicenter analysis. Arch Gynecol Obstet 294(3):615–622PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Vitale SG, Marilli I, Lodato M, Tropea A, Cianci A (2013) The role of cytoreductive surgery in advanced-stage ovarian cancer: a systematic review. Updates Surg 65(4):265–270PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Rossetti D, Vitale SG, Gulino FA, Rapisarda AMC, Valenti G, Zigarelli M, Sarpietro G, Frigerio L (2016) Laparoendoscopic single-site surgery for the assessment of peritoneal carcinomatosis resectability in patients with advanced ovarian cancer. Eur J Gynaecol Oncol 37(5):671–673PubMedGoogle Scholar
  38. 38.
    Laganà AS, Colonese F, Colonese E, Sofo V, Salmeri FM, Granese R, Chiofalo B, Ciancimino L, Triolo O (2015) Cytogenetic analysis of epithelial ovarian cancer’s stem cells: an overview on new diagnostic and therapeutic perspectives. Eur J Gynaecol Oncol 36(5):495–505PubMedGoogle Scholar
  39. 39.
    Laganà AS, Sofo V, Vitale SG, Triolo O (2016) Epithelial ovarian cancer inherent resistance: may the pleiotropic interaction between reduced immunosurveillance and drug-resistant cells play a key role? Gynecol Oncol Rep 18:57–58PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Hightower RD, Nguyen HN, Averette HE, Hoskins W, Harrison T, Steren A (1994) National survey of ovarian carcinoma. IV: Patterns of care and related survival for older patients. Cancer 73(2):377–383PubMedCrossRefGoogle Scholar
  41. 41.
    Fairfield KM, Lucas FL, Earle CC, Small L, Trimble EL, Warren JL (2010) Regional variation in cancer-directed surgery and mortality among women with epithelial ovarian cancer in the Medicare population. Cancer 116(20):4840–4848PubMedCrossRefGoogle Scholar
  42. 42.
    Thrall MM, Goff BA, Symons RG, Flum DR, Gray HJ (2011) Thirty-day mortality after primary cytoreductive surgery for advanced ovarian cancer in the elderly. Obstet Gynecol 118(3):537–547PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Moore KN, Reid MS, Fong DN, Myers TK, Landrum LM, Moxley KM, Walker JL, McMeekin DS, Mannel RS (2008) Ovarian cancer in the octogenarian: does the paradigm of aggressive cytoreductive surgery and chemotherapy still apply? Gynecol Oncol 110(2):133–139PubMedCrossRefGoogle Scholar
  44. 44.
    Cloven NG, Manetta A, Berman ML, Kohler MF, DiSaia PJ (1999) Management of ovarian cancer in patients older than 80 years of age. Gynecol Oncol 73(1):137–139PubMedCrossRefGoogle Scholar
  45. 45.
    Bruchim I, Altaras M, Fishman A (2002) Age contrasts in clinical characteristics and pattern of care in patients with epithelial ovarian cancer. Gynecol Oncol 86(3):274–278PubMedCrossRefGoogle Scholar
  46. 46.
    Aapro M, Extermann M, Repetto L (2000) Evaluation of the elderly with cancer. Ann Oncol 11(suppl 3):223–229PubMedCrossRefGoogle Scholar
  47. 47.
    Edmonson JH, Su J, Krook JE (1993) Treatment of ovarian cancer in elderly women. Mayo Clinic North Central Cancer Treatment Group studies. Cancer 71(2 suppl):615–617PubMedGoogle Scholar
  48. 48.
    Trillsch F, Woelber L, Eulenburg C, Braicu I, Lambrechts S, Chekerov R, van Nieuwenhuysen E, Speiser P, Zeimet A, Castillo-Tong DC, Concin N, Zeillinger R, Vergote I, Mahner S, Sehouli J (2013) Treatment reality in elderly patients with advanced ovarian cancer: a prospective analysis of the OVCAD consortium. J Ovarian Res 6(1):42PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Chiara S, Lionetto R, Vincenti M, Bruzzone M, Nobile MT, Gadducci A, Carnino F, Rosso R, Conte PF (2001) Advanced ovarian cancer in the elderly: results of consecutive trials with cisplatin-based chemotherapy. Crit Rev Oncol Hematol 37(1):27–34PubMedCrossRefGoogle Scholar
  50. 50.
    Nicoletto MO, Artioli G, Donach M, Sileni VC, Monfardini S, Talamini R, Veronesi A, Ferrazzi E, Tumolo S, Visonà E, Amichetti M, Endrizzi L, Salvagno L, Prosperi A, Azzoni P (2001) Elderly ovarian cancer: treatment with mitoxantrone-carboplatin. Gynecol Oncol 80(2):221–226PubMedCrossRefGoogle Scholar
  51. 51.
    Ceccaroni M, D’Agostino G, Ferrandina G, Gadducci A, Di Vagno G, Pignata S, Poerio A, Salerno MG, Fanucchi A, Lapresa MT, Tambaro R, Scambia G (2002) Gynecological malignancies in elderly patients: is age 70 a limit to standard-dose chemotherapy? An Italian retrospective toxicity multicentric study. Gynecol Oncol 85(3):445–450PubMedCrossRefGoogle Scholar
  52. 52.
    Gronlund B, Høgdall C, Hansen HH, Engelholm SA (2002) Performance status rather than age is the key prognostic factor in second-line treatment of elderly patients with epithelial ovarian carcinoma. Cancer 94(7):1961–1967PubMedCrossRefGoogle Scholar
  53. 53.
    Gershenson DM, Mitchell MF, Atkinson N, Silva EG, Burke TW, Morris M, Kavanagh JJ, Warner D, Wharton JT (1993) Age contrasts in patients with advanced epithelial ovarian cancer. The M.D. Anderson Cancer Center experience. Cancer 71(2 Suppl):638–643PubMedGoogle Scholar
  54. 54.
    Bicher A, Sarosy G, Kohn E, Adamo DO, Davis P, Jacob J, Chabner BA, Reed E (1993) Age does not influence taxol dose intensity in recurrent carcinoma of the ovary. Cancer 71(2 Suppl):594–600PubMedGoogle Scholar
  55. 55.
    Fourcadier E, Trétarre B, Gras-Aygon C, Ecarnot F, Daurès J-P, Bessaoud F (2015) Under-treatment of elderly patients with ovarian cancer: a population based study. BMC Cancer 15:937PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    US National Institutes of Health (2005) Cancer of the cervix uteri. http://www.cancer.gov. Accessed 20 Mar 2013
  57. 57.
    Goodwin JS, Samet JM, Hunt WC (1996) Determinants of survival in older cancer patients. J Natl Cancer Inst 88:1031–1038PubMedCrossRefGoogle Scholar
  58. 58.
    Schonberg MA, Marcantonio ER, Li D, Silliman RA, Ngo L, McCarthy EP (2010) Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival. J Clin Oncol 28(12):2038–2045PubMedPubMedCentralCrossRefGoogle Scholar
  59. 59.
    Cykert S, Dilworth-Anderson P, Monroe MH, Walker P, McGuire FR, Corbie-Smith G, Edwards LJ, Bunton AJ (2010) Factors associated with decisions to undergo surgery among patients with newly diagnosed early-stage lung cancer. JAMA 303(23):2368–2376PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    Samet J, Hunt WC, Key C, Humble CG, Goodwin JS (1986) Choice of cancer therapy varies with age of patient. JAMA 255:3385–3390PubMedCrossRefGoogle Scholar
  61. 61.
    Sharma C, Deutsch I, Horowitz DP, Hershman DL, Lewin SN, Lu YS, Neugut AI, Herzog TJ, Chao CK, Wright JD (2012) Patterns of care and treatment outcomes for elderly women with cervical cancer. Cancer 118(14):3618–3626PubMedCrossRefGoogle Scholar
  62. 62.
    Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, Favini G, Ferri L, Mangioni C (1997) Randomised study of radical surgery versus radiotherapy for stage Ib–IIa cervical cancer. Lancet 350(9077):535–540PubMedCrossRefGoogle Scholar
  63. 63.
    Rossetti D, Vitale SG, Tropea A, Biondi A, Laganà AS (2017) New procedures for the identification of sentinel lymph node: shaping the horizon of future management in early stage uterine cervical cancer. Updates Surg.  https://doi.org/10.1007/s13304-017-0456-6 CrossRefPubMedGoogle Scholar
  64. 64.
    Trimble EL, Harlan LC, Gius D, Stevens J, Schwartz SM (2008) Patterns of care for women with cervical cancer in the United States. Cancer 113:743–749PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Fuchtner C, Manetta A, Walker JL, Emma D, Berman M, DiSaia PJ (1992) Radical hysterectomy in the elderly patient: analysis of morbidity. Am J Obstet Gynecol 166:593–597PubMedCrossRefGoogle Scholar
  66. 66.
    Geisler JP, Geisler HE (1994) Radical hysterectomy in patients 65 years of age and older. Gynecol Oncol 53:208–211PubMedCrossRefGoogle Scholar
  67. 67.
    Giannice R, Susini T, Ferrandina G, Poerio A, Margariti PA, Carminati R, Marana E, Mancuso S, Scambia G (2001) Systematic pelvic and aortic lymphadenectomy in elderly gynecologic oncologic patients. Cancer 92(10):2562–2568PubMedCrossRefGoogle Scholar
  68. 68.
    Levrant SG, Fruchter RG, Maiman M (1992) Radical hysterectomy for cervical cancer: morbidity and survival in relation to weight and age. Gynecol Oncol 45:317–322PubMedCrossRefGoogle Scholar
  69. 69.
    Peters WA 3rd, Liu PY, Barrett RJ 2nd, Stock RJ, Monk BJ, Berek JS, Souhami L, Grigsby P, Gordon W Jr, Alberts DS (2000) Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 18(8):1606–1613PubMedCrossRefGoogle Scholar
  70. 70.
    Whitney CW, Sause W, Bundy BN, Malfetano JH, Hannigan EV, Fowler WC Jr, Clarke-Pearson DL, Liao SY (1999) Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol 17(5):1339–1348PubMedCrossRefGoogle Scholar
  71. 71.
    Morris M, Eifel PJ, Lu J, Grigsby PW, Levenback C, Stevens RE, Rotman M, Gershenson DM, Mutch DG (1999) Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med 340(15):1137–1143PubMedCrossRefGoogle Scholar
  72. 72.
    Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA, Clarke-Pearson DL, Insalaco S (1999) Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 341(9):708Google Scholar
  73. 73.
    Magné N, Mancy NC, Chajon E, Duvillard P, Pautier P, Castaigne D, Lhommé C, Morice P, Haie-Meder C (2009) Patterns of care and outcome in elderly cervical cancer patients: a special focus on brachytherapy. Radiother Oncol 91(2):197–201PubMedCrossRefGoogle Scholar
  74. 74.
    Mitchell PA, Waggoner S, Rotmensch J, Mundt AJ (1998) Cervical cancer in the elderly treated with radiation therapy. Gynecol Oncol 71:291–298PubMedCrossRefGoogle Scholar
  75. 75.
    Goodheart M, Jacobson G, Smith BJ, Zhou L (2008) Chemoradiation for invasive cervical cancer in elderly patients: outcomes and morbidity. Int J Gynecol Cancer. 18:95–103PubMedCrossRefGoogle Scholar
  76. 76.
    Ikushima H, Takegawa Y, Osaki K, Furutani S, Yamashita K, Kawanaka T, Kubo A, Kudoh T, Nishitani H (2007) Radiation therapy for cervical cancer in the elderly. Gynecol Oncol 107(2):339–343PubMedCrossRefGoogle Scholar
  77. 77.
    Minagawa Y, Kigawa J, Itamochi H, Terakawa N (1997) The outcome of radiation therapy in elderly patients with advanced cervical cancer. Int J Gynaecol Obstet 58:305–309PubMedCrossRefGoogle Scholar
  78. 78.
    Pignon T, Horiot JC, Bolla M, van Poppel H, Bartelink H, Roelofsen F, Pene F, Gerard A, Einhorn N, Nguyen TD, Vanglabbeke M, Scalliet P (1997) Age is not a limiting factor for radical radiotherapy in pelvic malignancies. Radiother Oncol 42(2):107–120PubMedCrossRefGoogle Scholar
  79. 79.
    Zachariah B, Balducci L, Venkattaramanabalaji GV, Casey L, Greenberg HM, Del Regato JA (1997) Radiotherapy for cancer patients aged 80 and older: a study of effectiveness and side effects. Int J Radiat Oncol Biol Phys 39:1125–1129PubMedCrossRefPubMedCentralGoogle Scholar
  80. 80.
    Grant PT, Jeffrey JF, Fraser RC, Tompkins MG, Filbee JF, Wong OS (1989) Pelvic radiation therapy for gynecologic malignancy in geriatric patients. Gynecol Oncol 33(2):185–188PubMedCrossRefGoogle Scholar
  81. 81.
    Vitale SG, La Rosa VL, Rapisarda AM, Laganà AS (2016) Comment on: “The consequences of gynaecological cancer in patients and their partners from the sexual and psychological perspective”. Prz Menopauzalny 15(3):186–187PubMedPubMedCentralGoogle Scholar
  82. 82.
    Vitale SG, La Rosa VL, Rapisarda AM, Laganà AS (2017) Comment on: “Anxiety and depression in patients with advanced ovarian cancer: a prospective study”. J Psychosom Obstet Gynaecol 38(1):83–84PubMedCrossRefGoogle Scholar
  83. 83.
    Laganà AS, La Rosa VL, Rapisarda AM, Vitale SG (2017) Comment on: “Needs and priorities of women with endometrial and cervical cancer”. J Psychosom Obstet Gynaecol 38(1):85–86PubMedCrossRefGoogle Scholar
  84. 84.
    Vitale SG, Rossetti D, Tropea A, Biondi A, Laganà AS (2017) Fertility sparing surgery for stage IA type I and G2 endometrial cancer in reproductive-aged patients: evidence-based approach and future perspectives. Updates Surg 69(1):29–34PubMedCrossRefGoogle Scholar
  85. 85.
    Vitale SG, La Rosa VL, Rapisarda AMC, Laganà AS (2017) Fertility preservation in women with gynaecologic cancer: the impact on quality of life and psychological well-being. Hum Fertil (Camb).  https://doi.org/10.1080/14647273.2017.1339365 CrossRefGoogle Scholar
  86. 86.
    Ferranti G, Prosperi Porta R, La Rosa VL, Vitale SG, Laganà AS (2017) Reflections on treatments for infertility and the possible occurrence of ovarian carcinomas. Recenti Prog Med 108(3):136–140PubMedGoogle Scholar
  87. 87.
    Laganà AS, La Rosa VL, Rapisarda AM, Platania A, Vitale SG (2017) Psychological impact of fertility preservation techniques in women with gynaecological cancer. Ecancermedicalscience 11:ed62PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Salvatore Giovanni Vitale
    • 1
  • Stella Capriglione
    • 2
  • Gabriella Zito
    • 3
  • Salvatore Lopez
    • 4
    • 5
  • Ferdinando Antonio Gulino
    • 6
  • Federica Di Guardo
    • 7
  • Amerigo Vitagliano
    • 8
  • Marco Noventa
    • 8
  • Valentina Lucia La Rosa
    • 9
  • Fabrizio Sapia
    • 10
  • Gaetano Valenti
    • 10
  • Agnese Maria Chiara Rapisarda
    • 10
  • Isabel Peterlunger
    • 11
  • Diego Rossetti
    • 12
  • Antonio Simone Laganà
    • 1
  1. 1.Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”University of MessinaMessinaItaly
  2. 2.Department of Obstetrics and GynecologyIstituto per la Sicurezza SocialeCailungo-Borgo MaggioreRepublic of San Marino
  3. 3.Department of Obstetrics and GynecologyInstitute for Maternal and Child Health-IRCCS “Burlo Garofolo”TriesteItaly
  4. 4.Department of Obstetrics, Gynecology, and Reproductive SciencesYale University School of MedicineNew HavenUSA
  5. 5.Department of Experimental and Clinical MedicineMagna Graecia UniversityCatanzaroItaly
  6. 6.Department of Obstetrics and GynaecologyUmberto I HospitalEnnaItaly
  7. 7.Department of General Surgery and Medical Surgical SpecialtiesUniversity of CataniaCataniaItaly
  8. 8.Department of Woman and Child HealthUniversity of PaduaPaduaItaly
  9. 9.Unit of Psychodiagnostics and Clinical PsychologyUniversity of CataniaCataniaItaly
  10. 10.Department of General Surgery and Medical Surgical SpecialtiesUniversity of CataniaCataniaItaly
  11. 11.Department of Medicine, Surgery and Health SciencesUniversity of Trieste, Ospedale di CattinaraTriesteItaly
  12. 12.Unit of Gynecology and ObstetricsDesenzano del Garda Hospital, Section of GavardoGavardoItaly

Personalised recommendations