Abstract
Purpose
The purpose of the study was to analyse outcomes with adjuvant concurrent chemoradiotherapy (cCRT) followed by adjuvant chemotherapy (AC) in radically resected gall bladder carcinoma (GBC) in Indian patients.
Methods and Materials
We retrospectively reviewed the records of GBC patients who received adjuvant cCRT after extended cholecystectomy (EC) between January 2007 and December 2011. Patterns of recurrence, disease-free survival (DFS), overall survival (OS) and adverse prognostic factors were evaluated.
Results
Thirty-two patients were analysed. At a median follow-up of 53 months, 40 % of patients had recurrence either locoregionally (12 %) or had distant metastases (28 %). The 5-year OS and DFS was 25 % and 53 %, respectively. When prognostic factors were evaluated, the median OS was 51 versus 23 months for node-negative (n = 8) versus node-positive disease (n = 24), not reached versus 34 months for stage 2 (n = 4) versus for stage 3 (n = 28), 46 versus 23 months for R0 (n = 11) versus R1 resection (n = 21), 51 versus 12 months (p = 0.15) for well-differentiated (n = 16) versus poorly differentiated tumours (n = 8), and 10 versus 51 months for lymphovascular invasion presence (n = 4) versus absence (n = 28) (p = 0.01).
Conclusion
Outcome in Indian patients with cCRT followed by AC is similar to that reported in the literature. Adjuvant cCRT followed by AC improves outcomes in patients with R1 and node-positive disease. Advanced stage, nodal positivity, poor differentiation, presence of perineural invasion and lymphovascular invasion are adverse prognostic features. Further research is required with treatment intensification in patients with adverse prognostic factors to improve outcome.
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References
Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer. 2006;118:1591–602.
Jarnagin WR, Ruo L, Little SA, et al. Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma: implications for adjuvant therapeutic strategies. Cancer. 2003;98:1689–700.
Study Group of Surgical Adjuvant Therapy for Carcinomas of the Pancreas and Biliary Tract, Tadahiro T, Hodaka A, Hideki Y, Yuji N, Takashi M, et al. Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma. Cancer. 2002;95:1685–95.
Horgan AM, Eitan A, Thomas W, Knox JJ. Adjuvant therapy in the treatment of biliary tract cancer: a systematic review and meta-analysis. J Clin Oncol. 2012;30(16):1934–40.
Kim WS, Choi DW, You DD, Han S-S, Kim Y-K, Lee K-W, et al. Risk factors influencing recurrence, patterns of recurrence, and the efficacy of adjuvant therapy after radical resection for gallbladder carcinoma. J Gastrointest Surg. 2010;14:679–87.
Mahantshetty UM, Palled SR, Engineer R, Homkar G, Shrivastava SK, Shukla PJ. Adjuvant radiation therapy in gallbladder cancers: 10 years experience at Tata Memorial Hospital. J Cancer Res Ther. 2006;2:52–6.
Yoshioka Y, Ogawa K, Oikawa H, Onishi H, Uchida N, Maebayashi T. Factors influencing survival outcome for radiotherapy for biliary tract cancer: a multicenter retrospective study. Radiother Oncol. 2014;110:546–52.
Howlader N, Noone AM, Krapcho M, et al.: SEER cancer statistics review, 1975–2008, National Cancer Institute. http://seer.cancer.gov/csr/1975_2008
de Groen PC, Gores GJ, LaRusso NF. Biliary tract cancers. N Engl J Med. 1999;341:1368–78.
Wagholikar GD, Behari A, Krishnani N. Early gallbladder cancer. J Am Coll Surg. 2002;194:137–41.
Ogura Y, Tabata M, Kawarada Y, Mizumoto R. Effect of hepatic invasion on the choice of hepatic resection for advanced carcinoma of the gallbladder: histologic analysis of 32 surgical cases. World J Surg. 1998;22:262–7.
Yamaguchi K, Chijiwa K, Shimizi S. Anatomical limit of extended cholecystectomy for gallbladder carcinoma involving the neck of the gallbladder. Int Surg. 1998;83:21–3.
Todoraki T, Kawamoto T, Takahashi H, Takada Y, Koike N, Otsuka M, et al. Treatment of gallbladder carcinoma by radical resection. Br J Surg. 1999;86:622–7.
Gold DG, Miller RC, Haddock MG, Gunderson LL, Quevedo F, Donohue JH, et al. Adjuvant therapy for gallbladder carcinoma. The mayo clinic experience. Int J Radiation Oncology Biol Phys. 2009;75(1):150–5.
Müller B, Sola JA, Carcamo M, Ciudad AM, Trujillo C, Cerda B. Adjuvant chemoradiation for resected gallbladder cancer: treatment strategies for one of the leading causes of cancer death in Chilean women. Indian J Cancer. 2013;50:184–8.
González ME, Giannini OH, González P, Saldaña B. Adjuvant radio-chemotherapy after extended or simple cholecystectomy in gallbladder cancer. Clin Transl Oncol. 2011;13:480–4.
Lim KH, Oh DY, Chie EK, Im SA, Kim TY, et al. Adjuvant concurrent chemoradiation therapy (CCRT) alone versus CCRT followed by adjuvant chemotherapy: which is better in patients with radically resected extrahepatic biliary tract cancer? A nonrandomized, single center study. BMC Cancer. 2009;9:345.
Todoraki T, Kawamoto T, Otsuka M, Koike N, Yoshida S, Takada Y. Benefits of combining radiotherapy with aggressive resection for stage IV gallbladder cancer. Hepatogastroenterology. 1999;46:1585–91.
Takada T, Amano H, Yasuda H, Nimura Y, Matsushiro T, Kato H, et al. Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? Cancer. 2002;95:1685–95.
Acknowledgments
We are thankful to Dr. Shree Bhide, Consultant in Clinical Oncology, Head Neck and GI Unit, Royal Marsden Hospital, London, UK, for providing a critique on this manuscript.
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This work has been presented in ASTRO 2012, Boston, USA.
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Agrawal, S., Gupta, P.K., Rastogi, N. et al. Outcomes of Adjuvant Chemoradiation and Predictors of Survival After Extended Cholecystectomy in Gall Bladder Carcinoma: a Single Institution Experience from an Endemic Region. J Gastrointest Canc 46, 48–53 (2015). https://doi.org/10.1007/s12029-014-9676-x
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DOI: https://doi.org/10.1007/s12029-014-9676-x