. Elderly patients are less likely to receive surgery and platinum- based combination chemotherapy than younger patients. We evaluated multi-institutional management of ovarian cancer in the elderly. Methods. Charts of women with ovarian, primary peritoneal or fallopian tube cancer from 1/1996- 6/2004, age ≥ 70 years were reviewed. Age, stage, medical co-morbidities, surgery, chemotherapy, treatment modification, toxicity and survival were analyzed. Chi-square, logistic regression and survival analysis were used. Results. Of 131 patients, 90 were ages 70- 79 (group 1 = G1) and 41 were >80 years of age (group 2 = G2). Surgery was performed in 80 patients in G1; 25 patients in G2 (P = 0.001). Among patients who underwent surgery, optimal debulking and post-operative complications did not differ between groups. Ninety-five percent of patients received platinum-based therapy and 83% received combination platinum/paclitaxel in G1, compared to 90% and 41% , respectively, in G2 (P < 0.001). Of those receiving platinum therapy, 36% in G1 and 41% in G2 required dose reductions or termination of therapy. Forty percent of G1 and 50% of G2 required a delay of therapy; the majority occurring in patients receiving combination therapy. Hematological toxicity increased with use of combination therapy, but not with advancing age or Charlson score. Successful debulking surgery significantly impacted survival, and when controlling for this factor, age was not a significant variable. Conclusion. The extreme elderly had a decreased likelihood of receiving surgery and combination chemotherapy despite equivalent co-morbidities. In this analysis, optimal surgical cytoreduction had the greatest impact on survival. Elderly patients are less likely to receive surgery and platinum-based combination chemotherapy than younger patients. We evaluated multi-institutional management of ovarian cancer in the elderly. Methods. Charts of women with ovarian, primary peritoneal or fallopian tube cancer from 1/1996 Age, stage ≥ 70 years were reviewed. Age, stage, medical co-morbidities, surgery, chemotherapy, treatment, toxicity and survival were were. Analyzed by Chi-square, logistic regression and survival analysis were used. Patients were 90 years old 70-79 (group 1 = G1) and 41 were> 80 years of age (group 2 = G2). Surgery was performed in 80 patients in G1; 25 patients in G2 Ninety-five percent of patients received platinum-based therapy and 83% received platinum / paclitaxel in G1, compared to 90% and 41% respectively, respectively, in G2 (P <0.001). Of those receiving platinum therapy, 36% in G1 and 41% in G2 required dose reductions or termination of therapy. Forty percent of G1 and 50% of G2 required a delay of therapy; the majority occurring in patients receiving combination therapy. Hematological Toxicity Increased with use of combination therapy, but not with advancing age or Charlson score. Successful deblking surgery significantly impacted survival, and when controlling for this factor, age was not a significant variable. in this analysis, optimal surgical cytoreduction had the greatest impact on survival.