Asian Pacific Journal of Cancer Prevention

Asian Pacific Organization for Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Radiological Downstaging with Neoadjuvant Therapy in Unresectable Gall Bladder Cancer Cases

  • Agrawal, Sushma (Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences) ;
  • Mohan, Lalit (Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences) ;
  • Mourya, Chandan (Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences) ;
  • Neyaz, Zafar (Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences) ;
  • Saxena, Rajan (Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences)
  • Published : 2016.06.01

Abstract

Background: Gall bladder cancer (GBC) usually presents as unresectable or metastatic disease. We conducted a feasibility study to evaluate the effect of neoadjuvant therapy (NAT) on radiologic downstaging and resectability in unresectable GBC cases. Materials and Methods: Patients with locally advanced disease were treated with chemoradiotherapy [CTRT] ( external radiotherapy (45Gy) along with weekly concurrent cisplatin $35mg/m^2$ and 5-FU 500 mg) and those with positive paraaortic nodes were treated with neoadjuvant chemotherapy [NACT (cisplatin $25mg/m^2$ and gemcitabine $1gm/m^2$ day 1 and 8, 3 weekly for 3 cycles). Radiological assessment was according to RECIST criteria by evaluating downstaging of liver involvement and lymphadenopathy into complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Results: A total of 40 patients were evaluated from January 2012 to December 2014 (CTRT=25, NACT=15). Pretreatment CT scans revealed involvement of hilum (19), liver infiltration (38), duodenum involvement (n=22), colon involvement (n=11), N1 involvement (n=11), N2 disease (n=8), paraaortic LN (n=15), and no lymphadenopathy (n=6). After neoadjuvant therapy, liver involvement showed CR in 11(30%), PR in 4 (10.5%), SD in 15 (39.4%) and lymph node involvement showed CR in 17 (50%), PR in 6 (17.6%), SD in 4 (11.7 %). Six patients (CTRT=2, NACT=4) with 66.6 % and 83% downstaging of liver and lymphnodes respectively underwent extended cholecystectomy. There was 16.6 % and 83.3% rates of histopathological CR of liver and lymph nodes. All resections were R0. Conclusions: Neoadjuvant therapy in unresectable gall bladder cancer results in a 15% resectability rate. This approach has a strong potential in achieving R0 and node negative disease. Radiologic downstaging (CR+PR) of liver involvement is 40.5% and lymphadenopathy is 67.5%. Nodal regression could serve as a predictor of response to neoadjuvant therapy.

Keywords

File

Download PDF

References

  1. ctep.cancer.gov/protocolDevelopment/electronic.../docs/ ctcaev3.pdf
  2. de Aretxabala X, Roa I, Burgos L, et al (1999). Preoperative chemoradiotherapy in the treatment of gallbladder cancer, Am Surg, 65, 241-6.
  3. https://cancerstaging.org/.../AJCC6th Ed Cancer Staging Manual Part1.pdf
  4. Gangopadhyay A, Nath P, Biswas J (2015). Reduced dose intensity of chemotherapy may not lead to inferior palliation in locally advanced carcinoma of the gall bladder: An experience from a regional cancer center in Eastern India, J Gastrointest Cancer, 46, 297-300 https://doi.org/10.1007/s12029-015-9742-z
  5. Kato A, Shimizu H, Ohtsuka M, et al (2013). Surgical resection after downsizing chemotherapy for initially unresectable locally advanced biliary tract cancer: a retrospective singlecenter study, Ann Surgical Oncol, 20, 318-24. https://doi.org/10.1245/s10434-012-2312-8
  6. Randi G, Franceschi S, La Vecchia C (2006). Gallbladder cancer worldwide:geographical distribution and risk factors, Int J Cancer, 118, 1591-2. https://doi.org/10.1002/ijc.21683
  7. Saxena R, Sikora SS, Kaushik SP (1995). A triple bypass procedure for advanced carcinoma of the neck of the gall bladder. Br J Surg, 82, 394-5. https://doi.org/10.1002/bjs.1800820337
  8. Sirohi B, Mitra A, Jagannath P, et al (2015). Neoadjuvant chemotherapy in patients with locally advanced gallbladder cancer. Future Oncol, 11, 1501-9. https://doi.org/10.2217/fon.14.308
  9. Therasse P, Arbuck SG, Eisenhauer EA, Kaplan RS, Rubinstein L (2000). New guidelines to evaluate the response to treatment in Solid Tumors. J Natl Cancer Inst, 9, 205-6.

Cited by

  1. Long-Term Survival with Chemoradiation Alone in Locally Advanced Unresectable Gallbladder Cancer: First Case Report of a New Paradigm vol.49, pp.2, 2018, https://doi.org/10.1007/s12029-016-9893-6
  2. Prognostic significance of neutrophil–lymphocyte ratio and carbohydrate antigen 19-9 in patients with gallbladder carcinoma vol.98, pp.8, 2019, https://doi.org/10.1097/MD.0000000000014550