Skip to main content
SpringerLink
Log in

Role of Radiation Therapy

  • Chapter
  • First Online:
Diseases of the Gallbladder

  • 454 Accesses

Abstract

Radiation therapy (RT) is a minimally invasive treatment for almost all organ cancers. Over the past few decades, irradiation technology has significantly advanced, with 3D conformal radiation now the standard therapy. Furthermore, creation of more sophisticated irradiation systems for high-precision radiotherapy, such as stereotactic radiotherapy, intensity-modulated radiotherapy, and image-guided radiotherapy, has made it possible to deliver higher radiation doses to each lesion with higher conformity. However, RT has not played a large role in gallbladder cancer (GBC) treatment. Currently, the only curative treatment is complete resection, with RT primarily a local treatment for unresectable advanced GBC or adjuvant therapy after surgery. Although unresectable local GBC has been treated with 5-fluorouracil-based chemoradiation, clinical studies have yet to establish definitive treatment regimens because of the very small number of patients. For adjuvant settings after resection, promising results have also been reported, but further studies on the criteria, optimal dose, and RT fields are needed. Since abdominal organs are constantly moving due to respiratory and peristaltic motions, this factor has prevented the use of high-precision RT technology from delivering high doses that are necessary for tumor control of GBC. However, recurrence patterns suggest that local control is important even for advanced GBC, and thus, ablative RT with stereotactic irradiation has been attempted. Furthermore, there have been new developments and introduction of new technologies that can respond to organ movements recently. Therefore, the role of RT for GBC is expected to significantly change in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Macdonald OK, Crane CH. Palliative and postoperative radiotherapy in biliary tract cancer. Surg Oncol Clin N Am. 2002;11:941–54.

    Article  Google Scholar 

  2. Verma V, Surkar SM, Brooks ED, Simone CB II, Lin C. Chemoradiotherapy versus chemotherapy alone for unresected nonmetastatic gallbladder cancer: national practice patterns and outcomes. J Natl Compr Canc Netw. 2018;16:59–65.

    Article  Google Scholar 

  3. Jaffray DA, Langen KM, Mageras G. Safety consideration for IGRT: executive summery. Pract Radiat Oncol. 2018;3(3):167–70.

    Article  Google Scholar 

  4. Houry S, Barrier A, Huguer M. Irradiation therapy for gallbladder carcinoma: recent advances. J Hepatobiliary Pancreat Surg. 2001;8:518–24.

    Article  CAS  Google Scholar 

  5. Engineer R, Wadasadawala T, Mehta S, Mahantshetty U, Purandare N, Rangarajan V, et al. Chemoradiation for unresectable gall bladder cancer: time to review historic nihilism? J Gastrointest Canc. 2011;42:222–7.

    Article  Google Scholar 

  6. Crane CH, Macdonald KO, Vauthey JN, Yehuda P, Brown T, Curley S, et al. Limitation of conventional doses of chemoradiation for unresectable biliary cancer. Int Radiat Oncol Biol Phys. 2002;53:969–74.

    Article  Google Scholar 

  7. Tao R, Krishnan S, Bhosale PR, Javle MM, Aloia TA, Shroff RT, et al. Ablative radiotherapy doses lead to a substantial prolongation of survival in patients with inoperable intrahepatic cholangiocarcinoma: a retrospective dose response analysis. J Clin Oncol. 2016;34:219–26.

    Article  CAS  Google Scholar 

  8. Pan CC, Kavanagh BD, Dawson LA, Li XA, Das SK, Miften M, et al. Radiation-associated liver injury. J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S94–100.

    Article  Google Scholar 

  9. Glazer ES, Liu P, Abdalla EK, Vauthey JN, Curley SA. Neither neoadjuvant nor adjuvant therapy increases survival after biliary tract cancer resection with wide negative margins. J Gastrointerest Surg. 2012;16:1666–71.

    Article  Google Scholar 

  10. Park HS, Lim JY, Yoon DS, Park JS, Lee DK, Lee SJ, et al. Outcome of adjuvant therapy for gallbladder cancer. Oncology. 2010;79:168–73.

    Article  CAS  Google Scholar 

  11. Ben-Joseph E, Guthrie KA, El-Khoueiry AB, Corless CL, Zaluoski MM, Lowy AM, et al. SWOG S0809: a phase II intergroup trial of adjuvant capecitabine and gemcitabine followed by radiotherapy and concurrent capecitabine in extrahepatic cholangiocarcinoma and gallbladder carcinoma. J Clin Oncol. 2015;33(24):2617–22.

    Article  Google Scholar 

  12. Kim Y, Amini N, Wilson A, Margonis GA, Ethun CG, Poultsides G, et al. Impact of chemotherapy and external beam radiation therapy on outcomes among patients with resected gallbladder cancer: a multi-institutional analysis. Ann Surg Oncol. 2016;23:2998–3008.

    Article  Google Scholar 

  13. Mantripragada KC, Hamid F, Shafqat H, Olszewski AJ. Adjuvant therapy for resected gallbladder cancer: analysis of the national cancer data base. J Natl Cancer Inst. 2017;109:djw202.

    Google Scholar 

  14. 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 Radiat Oncol Biol Phys. 2009;75:150–5.

    Article  CAS  Google Scholar 

  15. Kim BH, Kwon J, Chie EK, Kim K, Kim YH, Seo DW, et al. Adjuvant chemoradiotherapy is associated with improved survival for patients with resected gallbladder carcinoma: a systematic review and meta-analysis. Ann Surg Oncol. 2018;25:255–64.

    Article  Google Scholar 

  16. Kim GT. Patterns of initial failure after resection for gallbladder cancer: implications for adjuvant radiotherapy. Radiat Oncol J. 2017;35:359–67.

    Article  Google Scholar 

  17. Wang SJ, Lemieux A, Kalpathy-Cramer J, Ord CB, Walker GV, Fuller CD, et al. Nomogram for predicting the benefit of adjuvant chemoradiotherapy for resected gallbladder cancer. J Clin Oncol. 2011;29(35):4627–32.

    Article  Google Scholar 

  18. Bentzen SM, Constine LS, Deasy JO, Eisbruch A, Jackson A, Marks LB, et al. Quantitative analyses of normal tissue effects in the clinic (QUANEC): an introduction to the scientific issues. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S3–9.

    Article  Google Scholar 

  19. International Commission on Radiation Units and Measurements (ICRU) Report 50, Prescribing, Recording and Reporting Photon Beam Therapy. Bethesda, ICRU Publications, 1993.

    Google Scholar 

  20. International Commission on Radiation Units and Measurements (ICRU) Report 62, Prescribing, Recording and Reporting Photon Beam Therapy (Supplement to ICRU Report 50). Bethesda, ICRU Publications, 1999.

    Google Scholar 

  21. Bryan PJ, Custar S, Haaga JR, Balsara V. Respiratory movement of the pancreas: an ultrasonic study. J Ultrasound Med. 1984;3(7):317–20.

    Article  CAS  Google Scholar 

  22. Suramo I, Paivansalo M, Myllyla V. Cranio-caudal movements of the liver, pancreas and kidneys in respiration. Acta Radiol Diagn. 1984;25(2):129–31.

    Article  CAS  Google Scholar 

  23. Gierga DP, Chen GT, Kung JH, Betke M, Lombardi J, Willett CG. Quantification of respiration-induced abdominal tumor motion and its impact on IMRT dose distributions. Int J Radiat Oncol Biol Phys. 2004;58(5):1584–95.

    Article  Google Scholar 

  24. Bussels B, Goethals L, Feron M, Bielen D, Dymarkowski S, Suetens P, et al. Respiration-induced movement of the upper abdominal organs: a pitfall for the three-dimensional conformal radiation treatment of pancreatic cancer. Radiother Oncol. 2003;68(1):69–74.

    Article  Google Scholar 

  25. Feng M, Balter JM, Normolle D, Adusumilli S, Cao Y, Chenevert TL, et al. Characterization of pancreatic tumor motion using cine MRI: surrogates for tumor position should be used with caution. Int J Radiat Oncol Biol Phys. 2009;74(3):884–91.

    Article  Google Scholar 

  26. Shiinoki T, Shibuya K, Nakamura M, Nakamura A, Matsuo Y, Nakata M, et al. Interfractional reproducibility in pancreatic position based on four-dimensional computed tomography. Int J Radiat Oncol Biol Phys. 2011;80(5):1567–72.

    Article  Google Scholar 

  27. Langen KM, Jones DT. Organ motion and its management. Int J Radiat Oncol Biol Phys. 2002;50(1):265–78.

    Article  Google Scholar 

  28. Ge J, Santanam L, Noel C, Parikh PJ. Planning 4-dimensional computed tomography (4DCT) cannot adequately represent daily intrafractional motion of abdominal tumors. Int J Radiat Oncol Biol Phys. 2013;85:999–1005.

    Article  Google Scholar 

  29. Bortfeld T, Jokivarsi K, Goitein M, Kung J, Jiang SB. Effects of intra-fraction motion on IMRT dose delivery: statistical analysis and simulation. Phys Med Biol. 2002;47:2203–20.

    Article  Google Scholar 

  30. Dawson LA, Brock KK, Kazanjian S, Fitch D, McGinn CJ, Lawrence TS, et al. The reproducibility of organ position using active breathing control (ABC) during liver radiotherapy. Int J Radiat Oncol Biol Phys. 2001;51(5):1410–21.

    Article  CAS  Google Scholar 

  31. Shirato H, Shimizu S, Shimizu T, Nishioka T, Miyasaka K. Real-time tumor-tracking radiotherapy. Lancet. 1999;353(9161):1331–2.

    Article  CAS  Google Scholar 

  32. Hanazawa H, Takahashi S, Shiinoki T, Park SC, Yuasa Y, Koike M, et al. Clinical assessment of coiled fiducial markers as internal surrogates for hepatocellular carcinomas during gated stereotactic body radiotherapy with a real-time tumor-tracking system. Radiother Oncol. 2017;123:43–8.

    Article  Google Scholar 

  33. Kamino Y, Takayama K, Kokubo M, Narita Y, Hirai E, Kawawda N, et al. Development of a four-dimensional image-guided radiotherapy system with a gimbaled X-ray head. Int Radiat Oncol Biol Phys. 2006;66:271–8.

    Article  Google Scholar 

  34. Iizuka Y, Matsuo Y, Ishihara Y, Akimoto M, Tanabe H, Takayama K, et al. Dynamic tumor-tracking radiotherapy with real-time monitoring for liver tumors using a gimbal mounted linac. Radiother Oncol. 2015;117:496–500.

    Article  Google Scholar 

  35. Shiinoki T, Kawamura S, Uehara T, Yuasa Y, Kamomae T, Kotakebayashi T, et al. Quality assurance for respiratory-gated radiotherapy using the real-time tumor-tracking radiotherapy system. Int J Med Phys Clin Eng Radiat Oncol. 2014;3(3):125–32.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Osaka City University, Graduate School of Medicine, Osaka, Japan

    Keiko Shibuya

Authors
  1. Keiko Shibuya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Keiko Shibuya .

Editor information

Editors and Affiliations

  1. Department of Internal Medicine, NHIS Ilsan Hospital, Goyang-si, Kyonggi-do, Korea (Republic of)

    Jae Bock Chung

  2. Department of Internal Medicine, Kouri Hospital, Kansai Medical University, Neyagawa, Osaka, Japan

    Kazuichi Okazaki

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Shibuya, K. (2020). Role of Radiation Therapy. In: Chung, J., Okazaki, K. (eds) Diseases of the Gallbladder. Springer, Singapore. https://doi.org/10.1007/978-981-15-6010-1_22

Download citation

  • DOI: https://doi.org/10.1007/978-981-15-6010-1_22

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-6009-5

  • Online ISBN: 978-981-15-6010-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation