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New Treatments for Fallopian Tube Cancer

The fallopian tube is the least common site of origin in the female genital tract for cancer fallopian tube cancer. The most common histologic type of cancer, accounting for 90 percent of all malignancies of the tube, is papillary serous adenocarcinoma, but even this type is rare, with only 300 cases reported annually in the United States. The pattern of spread is similar to that seen with celomic epithelial lesions of the ovary, with dissemination throughout the peritoneal cavity perhaps the most important route of spread; hence, it is often difficult to distinguish between ovarian and fallopian tube primary tumors. Criteria have been set for lesions designated to be of fallopian tube origin: the main tumor arises from the endosalpinx and is in the tube, the histologic pattern.

In contradistinction to ovarian cancer, fallopian tube cancers tend to present at an earlier stage of development, with roughly 33 percent as stage I, 33 percent as stage II, and 33 percent as more advanced disease. The mainstay of therapy for patients with limited disease.

THERAPEUTIC DECISIONS IN FALLOPIAN TUBE CARCINOMAS

Firm recommendations on the management of fallopian tube carcinomas are difficult because of the lack of extensive clinical studies. Using the best evidence available, there are four basic groups of

Intramucosal Lesions Only

For patients with intramucosal lesions only, cure is excellent with surgical resection. Patients should undergo total abdominal hysterectomy and

Mucosal Wall Invasion

For patients with mucosal wall invasion, the recurrence rate approximates 50 percent. These patients are candidates for adjuvant therapy, but there are no data to support the use of such treatment. If adjuvant therapy is to be used, choices similar to those for high-risk ovarian carcinoma seem reasonable. If radiation therapy is to be used, it would seem appropriate to

Penetration of the Serosa

For patients with penetration of the serosa but no gross spread, recurrence rate exceeds 75 percent. An even stronger case for the use of adjuvant therapy can be made. The choices are

For patients with obvious spread of disease to locoregional and distant sites, platinum-based chemotherapy is a reasonable choice. The overall strategy should be similar to that used for patients with advanced or recurrent celomic epithelial carcinoma of the ovary.

is surgical resection. Whether postoperative radiation therapy is of value as an adjuvant treatment in patients whose tumors have been completely resected is unclear in the absence of a randomized trial. If radiation therapy does have a role, it would seem to be in patients.

Studies of chemotherapy in fallopian tube carcinoma are anecdotal. Agents noted to produce responses are the same noted to be active in celomic epithelial carcinoma of the ovary. It would seem reasonable to base the choice of systemic therapy in advanced or recurrent disease.

FUTURE DIRECTIONS

The development of additional information about the nature and management of germ cell cancers and rarer malignant tumors of the ovary as well as fallopian tube cancer will continue to be restricted by the low frequency of these lesions. With regard to celomic epithelial carcinomas

First, with regard to the biology of ovarian carcinoma, specific studies are seeking (1) to characterize factors associated with ovarian carcinoma and its outcome such as specific genetic

Second, the evolution of effective techniques for screening for and early detection of ovarian carcinoma has a high priority in ovarian carcinoma, the only one of the major gynecologic cancers for which early detection is not the rule. Most interest centers on the potential for

Third, although the efficacy of initial surgical cytoreduction in patients with stage III disease has been accepted on the basis of retrospective analyses, prospective trials are needed to address several important questions. One such study suggests an advantage for interval surgical cytoreduction at the midpoint of a series of chemotherapy courses. Prospective randomized

Fourth, efforts continue to investigate the role of new agents in the management of ovarian carcinoma. Current interest continues to center on further delineation of the role of paclitaxel. The plethora of new agents with activity in patients who are clinically resistant to the platinum

Finally, dose intensity continues to command significant interest. Three basic ways to enhance the dose intensity have been proffered: escalation of dose within the range that can be achieved without marrow reconstitution, high-dose chemotherapy with support of autologous bone

Although uncontrolled studies and anecdotal reports of high-dose chemotherapy with marrow reconstitution appear promising, the highly selected nature of the patients and the expense of the procedures mandate that randomized, comparative trials demonstrate the superiority of this

Intraperitoneal administration of drug, although under study for over a decade, still has no defined role in management. In the salvage setting, it appears to have no advantage over intravenous therapy. In the setting of first-line treatment, two large randomized trials in patients with small-volume disease show small advantages but have major design problems. The final determination of the role, if any, for intraperitoneal therapy awaits the completion of the

In conclusion, the future holds the promise of continuing advances in the management of patients with celomic epithelial carcinoma of the ovary. Although the explosion of knowledge of the basic nature of the disease holds the greatest potential for improvement, the identification of an effective screening technique, the clarification of the role of surgery in advanced disease, and the