ADENOCARCINOMA OF THE FALLOPIAN-TUBE - RESULTS OF A MULTIINSTITUTIONAL RETROSPECTIVE ANALYSIS OF 72 PATIENTS

Purpose/Objective: To determine the prognostic factors for predicting outcome of patients with adenocarcinoma of the fallopian tube and to e valuate the impact of treatment modalities in managing this uncommon d isease. Materials and Methods: A retrospective analysis of the tumor r egistries from 6 major medical centers from January 1, 1960 up to Marc h 31, 1995 yielded 72 patients with primary adenocarcinoma of the fall opian tube. The Dodson modification of the FIGO surgical staging as it applies to carcinoma of the fallopian tube was utilized. Endpoints fo r outcome included overall and disease-free survival. Univariate analy sis of host, tumor, and treatment factors was performed to determine p rognostic significance, and patterns of failure were reviewed. Results : The median age of the study cohort was 61 years (range 30-79 years). Stage distribution was 24 (33%) Stage I; 20 (28%) Stage II; 24 (33%) Stage III; and 4 (6%) Stage IV. Adjuvant chemotherapy was administered to 54 (75%) patients, and postoperative radiotherapy was employed in 22 (31%). In the latter treatment group, 14 (64%) had whole pelvic ext ernal beam irradiation, 5 (23%) whole abdominal radiotherapy, 2 (9%) P -32 instillation, and 1 (4%) vaginal brachytherapy alone. Chemotherapy was used in 67% of Stage I and in 79% of Stages II/III/IV disease (no t significant); radiotherapy was more commonly employed in Stage I tha n in Stages II/III/IV (46% vs. 23%, p = 0.05). The 5-, 8-, 15-year ove rall and disease-free survival for the study patients were 44.7%, 23.8 %, 18.8% and 27.3%, 17%, 14%, respectively. Significant prognostic fac tors of overall survival included Stage I vs. II/III/IV (p = 0.04) and age less than or equal to 60 years vs. >60 years at diagnosis (p = 0. 03). Only Stage I vs. II/III/IV (p = 0.05) was predictive of disease-f ree survival. Patterns of failure included 18% pelvic, 36% upper abdom inal, and 19% distant. For all patients, upper abdominal failures were more frequently found in Stages II/III/IV (29%) than in Stage I (7%) (p = 0.03). Relapses solely outside of what would be included in stand ard whole abdominal radiotherapy portals occurred for only 15% of pati ents (6 of 40) with failures. Furthermore, patients having any recurre nce, including the upper abdomen, were more likely (p = 0.001) to die (45%) than those without any type of relapse (18%). Conclusion: This r etrospective, multi-institutional study demonstrated the importance of PICO stage in predicting the overall and disease-free survival of pat ients with carcinoma of the fallopian tube. Future investigations shou ld consider exploring whole abdominal irradiation as adjunctive therap y, particularly in Stage IT and higher. (C) 1998 Elsevier Science Inc.