SGO: Fallopian Tube Carcinoma Similar to Ovarian Cancer

SAN DIEGO, March 5 -- Primary carcinoma of the fallopian tube should be treated as if it were epithelial ovarian cancer, researchers said here.

A retrospective case-control study of the rare malignancy -- which accounts for 1% of genital tract tumors -- shows that standard ovarian cancer treatment leads to similar overall and progression-free survival, according to Kathleen Moore, M.D., of the University of Oklahoma in Oklahoma City.

In fact, for stage I and II cancer, survival was significantly better than for the same stages of ovarian cancer, when women were treated with primary surgery, lymph node resection, and platinum-taxane adjuvant chemotherapy if indicated, Dr. Moore told a plenary session of the Society of Gynecologic Oncologists meeting here.

Bearing in mind the limitations of a retrospective study, Dr. Moore said, early-stage patients "do at least as well and may do better" than ovarian cancer patients of the similar stage, while there was no difference among late-stage patients.

The take-home message of the five-institution study, she said, "is pretty clear -- these cancers really do act like ovarian cancer."

Dr. Moore and colleagues studied records of 96 women with primary carcinoma of the fallopian tube, and compared them on a two-for-one basis with 190 matched controls with ovarian cancer.

More than half of the primary carcinoma of the fallopian tube patients (46) had stage I and II disease, and 42% were in stage I. The most common adjuvant chemotherapy regimen was carboplatinum and paclitaxel, in 84% and 86% of cases and controls, respectively.

Overall five-year survival for the early-stage patients was 95% for the primary carcinoma of the fallopian tube arm and 76% for the ovarian cancer arm, a difference that was statistically significant at P=0.02.

The improvement in progression-free survival was similar, she said.

On the other hand, three-year overall survival for advanced patients (stage III and IV) was identical at 59%, Dr. Moore reported.

There was also no significant difference in progression-free survival for patients with advanced cancers, she said.

While there appears to be a survival advantage for early primary carcinoma of the fallopian tube, Dr. Moore pointed out, the researchers were unable to adjust for the BRCA1 and 2 susceptibility mutations, which may differ between the arms.

She noted that the mutations are found in between 11% and 17% of primary carcinoma of the fallopian tube patients, and 44% of cancers found in the course of prophylactic surgery are of tubal origin.

"The study further strengthens the long-held opinion that the clinical behavior of fallopian tube cancer is similar to that of ovarian cancer," said David Gershenson, M.D., of the M.D. Anderson Cancer Center in Houston.

One implication is that patients with primary carcinoma of the fallopian tube should be eligible for clinical trials in ovarian cancer, Dr. Gershenson said in a formal discussion of the study. But, he added, it's still not clear that the early stages of both cancers are the same.