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 patients.
Intramucosal Lesions Only
For patients with intramucosal lesions only, cure is excellent with surgical resection. Patients should undergo total abdominal hysterectomy and bilateral salpingo-oophorectomy, followed closely with no further therapy.
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 treat the entire abdominal cavity. A preferable approach would be the use of platinum-based chemotherapy on the assumption that this disease responds similarly to celomic epithelial carcinoma.
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 similar to those noted above.
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.