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Neoadjuvant Chemoradiation Followed by Surgery for Locally Advanced Gallbladder Cancers: A New Paradigm

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Locally advanced (T3/T4) gallbladder cancers with large fixed portal nodes have a dismal prognosis. If undertaken, surgery entails extensive resections with high morbidity; therefore, in many centers, patients are offered palliative chemotherapy. In this prospective study, we used neoadjuvant concurrent chemoradiation with the intention of downstaging and facilitating R0 resection of these tumors.

Patients and Methods

Twenty-eight patients with locally advanced carcinoma gallbladder (stage III, having deep liver infiltrations and/or large portal nodes) underwent prior positron emission tomography/computed tomography to rule out metastatic disease. All were treated with concomitant chemoradiation using helical tomotherapy (dose of 57 Gy over 25 fractions to the gross tumor and 45 Gy over 25 fractions to the surrounding nodes) with injectable gemcitabine (300 mg/m2/week × 5 weeks).

Results

Of the 28 patients, 25 (89 %) successfully completed planned chemoradiation and 20 (71 %) achieved partial or complete radiologic response. Eighteen (64 %) patients were surgically explored, of whom 14 (56 %) achieved R0 resection. At the median follow-up of 37 months for the surviving patients, the median overall survival (OS) was 20 months for all patients. Only one patient recurred in the common bile duct postsurgery, whereas six patients had distant metastasis. The 5-year OS was 24 % for all patients and 47 % for patients with R0 resection. Biliary leak was seen in 6 (43 %) patients, of whom two required interventions.

Conclusion

Locally advanced unresectable cancers may benefit from neoadjuvant chemoradiation to facilitate a curative resection with a good survival.

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Authors and Affiliations

  1. Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India

    Reena Engineer DNB, Supriya Chopra MD & S. K. Shrivastava MD

  2. Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India

    Mahesh Goel MS & Shailesh Shrikhande MS

  3. Department of Medical Gastroenterology, Tata Memorial Hospital, Mumbai, India

    Prachi Patil DNB (Gastro) & S. Mehta DNB (Gastro)

  4. Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, India

    Nilendu Purandare MD & Venkatesh Rangarajan MD

  5. Department of Medical Physics, Tata Memorial Hospital, Mumbai, India

    Reena Ph DipRT

  6. Department of Surgical Pathology, Tata Memorial Hospital, Mumbai, India

    Munita Bal MD

Authors
  1. Reena Engineer DNB
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  2. Mahesh Goel MS
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  3. Supriya Chopra MD
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  4. Prachi Patil DNB (Gastro)
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  5. Nilendu Purandare MD
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  6. Venkatesh Rangarajan MD
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  7. Reena Ph DipRT
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  8. Munita Bal MD
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  9. Shailesh Shrikhande MS
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  10. S. K. Shrivastava MD
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  11. S. Mehta DNB (Gastro)
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Corresponding author

Correspondence to Reena Engineer DNB.

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Engineer, R., Goel, M., Chopra, S. et al. Neoadjuvant Chemoradiation Followed by Surgery for Locally Advanced Gallbladder Cancers: A New Paradigm. Ann Surg Oncol 23, 3009–3015 (2016). https://doi.org/10.1245/s10434-016-5197-0

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  • DOI: https://doi.org/10.1245/s10434-016-5197-0

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