Postoperative radiotherapy for gallbladder cancer.

Abstract

289 Background: Gallbladder cancer (GBC) is a relatively uncommon malignancy with high recurrence rate and poor prognosis, even after curative resection. Although postoperative radiotherapy (RT) has been tried to improve the poor results of surgery alone, the benefit of postoperative RT for GBC is still a matter of debate. The present study aimed to evaluate the effect of postoperative RT on locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) in patients with GBC. Methods: Between March 1998 and July 2009, 228 patients with GBC (T2-3 N0-2) underwent surgical resection with potentially curative aim (R0 or R1) at Asan Medical Center. Among the 228 patients, 86 received postoperative RT (RT group) with or without concurrent chemotherapy, and 142 did surgery alone (no-RT group). All patients with postoperative RT received three-dimensional conformal radiotherapy, and the median radiation dose was 50 Gy (range, 45-60 Gy) at 1.8 or 2.0 Gy/fraction daily. Among them, 57 patients (66.3%) had concurrent chemotherapy based on 5-fluorouracil. Results: The median follow-up time was 90 months (range, 35-96 months) for the surviving patients. Although RT group had significantly more advanced disease in overall stage (p = 0.005), T stage (p = 0.002), N stage (p = 0.010), and higher rate of R1 resection (p = 0.027), the 3-year LRC was 78% for RT group and 66% for no-RT group (p = 0.088). Also, there was no significant difference in the 3-year DFS and OS: 51% vs. 52% (p = 0.994) and 53% vs. 56% (p = 0.541), respectively. In multivariate analysis, postoperative RT was a significant predictive factor of improved LRC (p = 0.011), DFS (p = 0.016) and OS (p = 0.036). Conclusions: Although RT group had more adverse risk factors, the treatment outcomes of RT group were similar to those of no-RT group. Moreover, postoperative RT was a significant predictor of improved LRC, DFS and OS after adjusting these factors. These results suggest that postoperative RT might be effective in locoregional control and survival for patients with GBC.

A systematic review of the effectiveness of adjuvant therapy for patients with gallbladder cancer

“…15 The 24 observational studies consisted of 4 retrospective cohort studies, [16][17][18][19] with a total of 1772 patients; two PBCS (2867 patients), 20,21 and 18 retrospective PS (1130 patients). 2,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] In all this represents a total of 55 studies and 9887 patients with GBC treated with curative surgical intent.…”

“…In a series of patients resected with curative intent, some of whom underwent adjuvant CT or adjuvant CRT, we verified improvement of OS in patients with R1 (HR: 0.38 [0.23, 0.65]) vs. surgery alone (HR: 0.26 [0.15, 0.43]). 35 In other series, it was found that "surgical margin" is a factor of poor prognosis; as the Kasumova study (OR: 1,207 [0.066, 1.367]) 23 Kim's (HR: 6,981 [2,378,20,491], p < 0.001) 24 ; that of Jeong who reported 40% and 14% SV at 5 years for R0 and R1 respectively (p = 0.001) 28 ; and those of Yang and Ye, who reported OS in stage IV patients at 1, 3 and 5 years of 14.2%, 7.2% and 7.2%; and 71.4%, 9.5%, and 4.8% respectively. 32,33 A small number of patients, who underwent extended cholecystectomy, in which the results of CRT followed by CT were analyzed, showed that the median OS in patients with R0 and R1 was 46 and 23 months respectively 26 (type 4 treatment and prognosis studies).…”

“…No differences were observed in DFS at 3 years 51% vs. 52% (p = 0.994); although the RT subgroup generally presented more advanced disease stage T, stage N, and higher resection rate R1 (p = 0.027). 31 In another PS of stage III-IV patients treated with combined resection with adjuvant RT, an OS at 1, 3, and 5 years was observed for stage III patients, of 56%, 24%, and 18% respectively; in surgery alone, 43%, 23% and 17% respectively (p < 0.05). On the other hand, the OS at 1, 3 and 5 years of stage IV patients of the RT subgroup was 14%, 7% and 7% respectively; in surgery alone, it was 10%, 4% and 2% (p < 0.05).…”

“…Information was obtained from 1 SR, 15 1 PBCS 21 and 3 retrospective PS 25,31,32 ; that included a total of 4039 patients treated with adjuvant RT.…”

“…Information was obtained from 3 SR, 3,4,15 2 retrospective cohort studies 16,17 and 7 retrospective PS 23,24,26,28,32,33,35 representing a total of 6277 patients in these conditions, treated with some adjuvant therapy.…”