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

Engineer, Reena; Goel, Mahesh; Chopra, Supriya; Patil, Prachi; Purandare, Nilendu; Rangarajan, Venkatesh; Ph, Reena; Bal, Munita; Shrikhande, Shailesh V.; Shrivastava, Shyam K.; Mehta, Shaesta

doi:10.1245/s10434-016-5197-0

Cited by 65 publications

(39 citation statements)

References 22 publications

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“…The heterogeneity in the data should be noted: the mix of symptomatic and incidental cancers; gallbladder and other extrahepatic cholangiocarcinomas, studies also including intrahepatic cholangiocarcinomas; the type and duration of chemotherapy used in various time intervals; and a selection bias for both surgery and adjuvant therapy in most of the reports. As the concept of neoadjuvant therapy is not possible, by definition, in incidental gallbladder cancers, and symptomatic cancers may have a different inherent biology, findings from the present data would need to be extrapolated. Consequently, guidelines and consensus statements are vague, but recommend adjuvant chemotherapy for most patients after resection, in particular those with any T2 disease and above with N1 disease, given the high risk of recurrence and nodal dissemination.…”

Section: Resultsmentioning

confidence: 97%

Systematic review of management of incidental gallbladder cancer after cholecystectomy

Søreide

Guest

Harrison

et al. 2019

Journal of British Surgery

112

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Background Gallbladder cancer is rare, but cancers detected incidentally after cholecystectomy are increasing. The aim of this study was to review the available data for current best practice for optimal management of incidental gallbladder cancer. Methods A systematic PubMed search of the English literature to May 2018 was conducted. Results The search identified 12 systematic reviews and meta‐analyses, in addition to several consensus reports, multi‐institutional series and national audits. Some 0·25–0·89 per cent of all cholecystectomy specimens had incidental gallbladder cancer on pathological examination. Most patients were staged with pT2 (about half) or pT1 (about one‐third) cancers. Patients with cancers confined to the mucosa (T1a or less) had 5‐year survival rates of up to 100 per cent after cholecystectomy alone. For cancers invading the muscle layer of the gallbladder wall (T1b or above), reresection is recommended. The type, extent and timing of reresection remain controversial. Observation time may be used for new cross‐sectional imaging with CT and MRI. Perforation at initial surgery had a higher risk of disease dissemination. Gallbladder cancers are PET‐avid, and PET may detect residual disease and thus prevent unnecessary surgery. Routine laparoscopic staging before reresection is not warranted for all stages. Risk of peritoneal carcinomatosis increases with each T category. The incidence of port‐site metastases is about 10 per cent. Routine resection of port sites has no effect on survival. Adjuvant chemotherapy is poorly documented and probably underused. Conclusion Management of incidental gallbladder cancer continues to evolve, with more refined suggestions for subgroups at risk and a selective approach to reresection.

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Section: Resultsmentioning

confidence: 97%

Systematic review of management of incidental gallbladder cancer after cholecystectomy

Søreide

Guest

Harrison

et al. 2019

Journal of British Surgery

112

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“…The role of chemoradiation in neo‐adjuvant setting has been reported only in two studies with one of them showing a potential detrimental effect . We have recently reported our experience of use of NACT/RT in 28 patients with a resectability rate of 56% and a 5‐year OS for 47% for patients undergoing resection . The twenty‐one patients who received NACT/RT in our series were a part of this study with similar outcomes.…”

Section: Discussionmentioning

confidence: 65%

“…Surgery was performed after 3‐4 cycles of chemotherapy comprising of gemcitabine/cisplatin or gemcitabine/oxaliplatin. Neo‐adjuvant chemoradiation (NACT/RT) using intensity‐modulated radiotherapy (IMRT) was administered as a part of an ongoing institutional review board approved phase II study . The dose to the gross tumor was 57 Gy over 25 fractions in 5 weeks, whereas the clinical target volume (CTV) received 45 Gy over 25 fractions.…”

Section: Methodsmentioning

confidence: 99%

Emerging role of multimodality treatment in gall bladder cancer: Outcomes following 510 consecutive resections in a tertiary referral center

Patkar

Ostwal

Ramaswamy

et al. 2017

Journal of Surgical Oncology

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“…However two recent studies; one from Tata memorial, Mumbai and another from SGPGI, Lucknow has shown that use of Neoadjuvant Chemoradiotherapy benefitted the locally advanced carcinoma gall bladder patients in facilitating the resectability rate with a chance of improved survival. 28,29 With the current approach of extended cholecystectomy and chemotherapy regimen it is unlikely that further improvement in survival will be achieved. Development of targeted agents based on understanding of molecular biology has the potential for further improvement in survival.…”

Section: Survival Functionsmentioning

confidence: 99%

Carcinoma of the gall bladder: 8 year experience from a tertiary care centre, Punjab, India

Sharma¹,

Singh²

2019

Int Surg J

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Background: Gall bladder carcinoma is the most common malignancy of biliary tract and one of the most aggressive gastrointestinal malignancies. The present study was conducted to know the clinical aspects, results and survival patterns after therapeutic interventions in patients of gall bladder cancer.Methods: The study is retrospective analysis of prospectively collected data of gall bladder cancer patients.Results: In 288 gall bladder cancer patient’s median age was 60 yrs. There were 219 females, 69 males (F:M=3.2:1). Median number of days from the onset of symptoms to presentation was 24.5 days. Majority of patients were stage IVB 162 (56.3%), least were stage I 3(1%). 192 (66.7%) patients received palliative treatment because of unresectable malignancy. 39 (13.5%) patients underwent noncurative surgical intervention. 57 (19.8%) patients underwent extended cholecystectomy. The median number of lymph nodes detected on histopathological examination was 4.5 (range 3-12). 21 patients (36.8%) had positive lymph nodes. Median follow up of all patients was 6 months (1-66 months). 27 (9.4%) patients survived till last date of follow up. Median survival time in groups undergoing extended cholecystectomy, noncurative surgery, chemotherapy alone was 12, 8 and 4 months respectively. The difference in median survival time between the groups was statistically significant, Log rank (Mantel-Cox) χ2=109.78, p=0.00.Conclusions: Carcinoma of the gall bladder predominately affects females. Majority of patients had delayed presentation, stage IVB. Extended cholecystectomy is the only effective treatment to achieve long term survival.

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

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

Cited by 65 publications

References 22 publications

Systematic review of management of incidental gallbladder cancer after cholecystectomy

Systematic review of management of incidental gallbladder cancer after cholecystectomy

Emerging role of multimodality treatment in gall bladder cancer: Outcomes following 510 consecutive resections in a tertiary referral center

Carcinoma of the gall bladder: 8 year experience from a tertiary care centre, Punjab, India

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