Abstract
Purpose
To analyse results of combined treatment of adjuvant radio-chemotherapy (RT-CT) in patients diagnosed with gallbladder cancer (GBC) after complete resection. Methods and material From June 1993 until July 2006, 67 patients with a diagnosis of GBC who underwent R0 surgical resection and were staged as T1b-2-3N0-1M0 received adjuvant RT-CT. Radiotherapy consisted of whole abdominal irradiation (20 Gy at 100 cGy daily) plus a boost to the tumour bed for a total of 45–59.4 Gy. Concomitant chemotherapy (fluoropyrimidines) was given. Overall survival (OS) and median survival were analysed in relation to different prognostic factors.
Results
With a median follow-up of 90 months, 5-year OS was 41%, in the group who underwent extended cholecystectomy it reached 57% and it was only 27% in those who underwent simple cholecystectomy (p=0.005). Median survival was 42 months for the whole population, not yet reached for the extended cholecystectomy subgroup and 23 months for the simple cholecystectomy subgroup. When analysing for histological grade, median survival was 23 months for those graded as high grade (III or IV) and 57 months for those of low-unknown grade (p=0.029). In multivariate analysis, a statistically significant OS benefit was found for those who underwent extended cholecystectomy (p=0.003).
Conclusions
In the absence of randomised studies, these data support the use of extended cholecystectomy followed by adjuvant RT-CT in patients diagnosed as stages T1b-2-3N0-1M0 GBC after R0 resection.
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References
Jemal A, Siegel R, Ward E et al (2007) Cancer statistics, 2007. CA Cancer J Clin 57:43–66
http://deis.minsal.cl/deis/salidas06/causas06.asp?temp=TODAS_EDADES_MUJ.htm
Donohue JH, Stewart AK, Menck HR (1998) The National Cancer Data Base report on carcinoma of the gallbladder, 1989–1995. Cancer 83:2618–2628
Tsukada K, Hatakeyama K, Kurosaki I et al (1996) Outcome of radical surgery for carcinoma of the gallbladder according to the TNM stage. Surgery 120:816–821
Bloechle C, Izbicki JR, Passlick B et al (1995) Is radical surgery in locally advanced gallbladder carcinoma justified? Am J Gastroenterol 90:2195–2200
Yamamoto M, Onoyama H, Ajiki T et al (1999) Surgical results of operations for carcinoma of the gallbladder. Hepatogastroenterology 46:1552–1556
Shirai Y, Yoshida K, Tsukada K et al (1992) Inapparent carcinoma of the gallbladder. An appraisal of a radical second operation after simple cholecystectomy. Ann Surg 215:326–331
Bartlett DL, Fong Y, Fortner JG et al (1996) Long-term results after resection for gallbladder cancer. Implications for staging and management. Ann Surg 224:639–646
Matsumoto Y, Fujii H, Aoyama H et al (1992) Surgical treatment of primary carcinoma of the gallbladder based on the histologic analysis of 48 surgical specimens. Am J Surg 163:239–245
de Aretxabala XA, Roa IS, Burgos LA et al (1997) Curative resection in potentially resectable tumours of the gallbladder. Eur J Surg 163:419–426
Shirai Y, Yoshida K, Tsukada K et al (1992) Early carcinoma of the gallbladder. Eur J Surg 158:545–548
Wakai T, Shirai Y, Yokoyama N et al (2001) Early gallbladder carcinoma does not warrant radical resection. Br J Surg 88:675–678
Yamaguchi K, Tsuneyoshi M (1992) Subclinical gallbladder carcinoma. Am J Surg 163:382–386
Sun CD, Zhang BY, Wu LQ et al (2005) Laparoscopic cholecystectomy for treatment of unexpected early-stage gallbladder cancer. J Surg Oncol 91:253–257
Yoshida T, Matsumoto T, Sasaki et al (2000) Laparoscopic cholecystectomy in the treatment of patients with gall bladder cancer. J Am Coll Surg 191:158–163
Greene FL, Page DL, Fleming ID et al (eds) (2002) American Joint Committee on Cancer (AJCC) cancer staging manual, 6th edn. Springer, New York
Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481
Mantel N (1966) Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 50:163–170
Cox DR (1972) Regression models and life tables. J R Stat Soc B 34:187–220
Ogura Y, Mizumoto R, Isaji S et al (1991) Radical operations for carcinoma of the gallbladder: present status in Japan. World J Surg 15:337–343
Bosset JF, Mantion G, Gillet M et al (1989) Primary carcinoma of the gallbladder: adjuvant postoperative external irradiation. Cancer 64:1843–1847
Suzuki K, Kimura T, Ogawa H (2000) Longterm prognosis of gallbladder cancer diagnosed after laparoscopic cholecystectomy. Surg Endosc 14:712–716
Whalen GF, Bird I, Tanski W et al (2001) Laparoscopic cholecystectomy does not demonstrably decrease survival of patients with serendipitously treated gallbladder cancer. J Am Coll Surg 192:189–195
Kresl JJ, Schild SE, Henning GT et al (2002) Adjuvant external beam radiation therapy with concurrent chemotherapy in the management of gallbladder carcinoma. Int J Radiat Oncol Biol Phys 52:167–175
Czito BG, Hurwitz HI, Clough RW et al (2005) Adjuvant external-beam radiotherapy with concurrent chemotherapy after resection of primary gallbladder carcinoma: a 23-year experience. Int J Radiat Oncol Biol Phys 62:1030–1034
Baeza MR, Reyes JM, del Castillo C et al (2005) Post-operative adjuvant radiochemotherapy in the treatment of gallbladder cancer [Abstract]. Int J Radiat Oncol Biol Phys 63[Suppl]:S285–S286
Wang SJ, Fuller CD, Kim JS et al (2008) Prediction model for estimating the survival benefit of adjuvant radiotherapy for gallbladder cancer. J Clin Oncol 26:2112–2117
Baeza MR, Giannini O, Rivera R et al (2001) Adjuvant radiochemotherapy in the treatment of completely resected, locally advanced gastric cancer. Int J Radiat Oncol Biol Phys 50:645–650
Roa I, de Aretxabala X, Araya JC et al (2002) Morphological prognostic elements in gallbladder cancer. Rev Med Chil 130:387–395
Bartlett DL, Ramanathan RK, Ben-Josef E (2008) Cancer of the biliary tree. In: DeVita VT Jr, Hellman S, Rosenberg SA (eds) Cancer: principles and practice of oncology, 8th edn. Lippincott Williams & Wilkins, pp 1156–1186
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González, M.E., Giannini, O.H., González, P. et al. Adjuvant radio-chemotherapy after extended or simple cholecystectomy in gallbladder cancer. Clin Transl Oncol 13, 480–484 (2011). https://doi.org/10.1007/s12094-011-0685-y
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DOI: https://doi.org/10.1007/s12094-011-0685-y