The relevance of adjuvant therapy in primary carcinoma of the fallopian tube, stages I and II: Irradiation VS. chemotherapy

Introduction: Primary carcinoma of the Fallopian tube (FTC) is a rare but e xtremely aggressive neoplasm. It must be expected to cause up to 40% of tum or-related deaths even in Stage I, and up to 57% in Stage II. Due to its ra rity, there exist only a few and divergent reports on the value of adjuvant therapy. Therefore the present study aims at evaluating the influence of p ostoperative adjuvant therapy on FTC by studying the effects of irradiation and chemotherapy on the overall survival of patients in Stages I and II. Patients and Methods: We investigated 95 cases of FTC in Stages I (n = 66) and II (n = 29) in a retrospective multicenter study, Group I (n = 32) are patients who underwent a complete irradiation with cobalt or photon energie s of 23 MV (administering a daily dose of 2 Gy resulted in a total of 45-52 Gy in the pelvic areas). Group II (n = 31) consists of those cases who rec eived postoperative chemotherapy with platinum. Thirty-two women were exclu ded from this study because they had other chemotherapies, incomplete irrad iation, or no adjuvant therapy at all. Results: Median survival time was 57 months in Group I patients (95% confid ence interval 33-81 months), compared to 73 months (95% confidence interval , 68-78 months) in the chemotherapeutically treated Group II. This differen ce did not prove to be statistically significant (p = 0.476). If primary surgical therapy is included in the evaluation, and patients wit h total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (B SO) are compared to those with additional radical lymphadencetomy (TAH+BSOlymph nodes), the latter group's overall survival essentially improves but fails to reach statistical significance. Their 5-year survival rate is 83% against 58% in the TAH+BSO group (p = 0.12). Conclusion: Chemotherapy and irradiation are two adjuvant therapies that ar e similarly effective in FTC of Stages I and II, with chemotherapy being pr eferred at the present time. Primary surgical treatment, however, is of cru cial impact on the prognosis of FTC. (C) 2000 Elsevier Science Inc.