Adjuvant radiotherapy in the treatment of gall bladder carcinoma: What is the current evidence

Abstract

Gall bladder carcinoma (GBC) is considered the fifth most common one of the most aggressive gastro intestinal tract malignancies. Owing to their large incidence randomised controlled trials have hardly been conducted to look into their optimum treatment. Over the years surgical resection has been considered the only curative treatment of these tumors. However, the outcome still remains guarded. The predominant pattern of failure is loco-regional followed by systemic. Hence, local adjuvant radiation has been used by different institutes with concurrent and adjuvant chemotherapy. The large retrospective series with their limitations showed improved survival in patients with regional spread or tumors infiltrating the liver when treated with adjuvant radiotherapy. In the present era with modern radiation techniques and target delineation radiation may further improve upon the impact without adding to the toxicity profile. Hence, radiation in gall bladder cancer needs a relook to optimize treatment outcome of such aggressive disease.

Impact of chemotherapy and external beam radiation therapy on outcomes among patients with resected gallbladder cancer: A multi-institutional analysis.

“…3,11,21,25 Radiotherapy is commonly administered with concurrent chemotherapy, and most studies that have reported a benefit of adjuvant radiotherapy included patients treated with concurrent chemotherapy. 1,4,16 As noted in the current study, the locoregional benefit of adjuvant cXRT may be only relevant when systemic control of disease also is addressed, as the majority of recurrences (86 %) were distant in nature. Given that distant recurrence is more common than locoregional recurrence, CTx has been proposed as a more effective adjuvant strategy than cXRT.…”

“…21 Collectively, data from the current study as well as previous reports suggest that administration of systemic CTx with the integration of cXRT may be the optimal adjuvant strategy for patients with resected GBC characterized by highrisk features. 1,5,9,26 Several limitations should be considered when interpreting the data. The collaboration among multiple different institutions limited the ability to standardize treatment criteria.…”

“…2 Whereas complete surgical resection remains the only potentially curative treatment option for patients with GBC, the outcome of patients with advanced disease is dismal with 5-year survival ranging from 5 to 40 %. 1,[3][4][5] Previous studies have reported a high incidence of locoregional or distant recurrence after surgical resection for GBC, suggesting the need for additional therapeutic modalities following surgical resection. 6,7 The role of adjuvant therapy for GBC, however, remains unclear.…”

Impact of Chemotherapy and External-Beam Radiation Therapy on Outcomes among Patients with Resected Gallbladder Cancer: A Multi-institutional Analysis

“…1 The American Cancer Society estimates that there will be approximately 11,000 gallbladder and extrahepatic bile duct cancer cases resulting in nearly 3,700 deaths in the United States in 2015. 2 Whereas complete surgical resection remains the only potentially curative treatment option for patients with GBC, the outcome of patients with advanced disease is dismal with 5-year survival ranging from 5 to 40 %.…”

“…2 Whereas complete surgical resection remains the only potentially curative treatment option for patients with GBC, the outcome of patients with advanced disease is dismal with 5-year survival ranging from 5 to 40 %. 1,3–5 Previous studies have reported a high incidence of locoregional or distant recurrence after surgical resection for GBC, suggesting the need for additional therapeutic modalities following surgical resection. 6,7 The role of adjuvant therapy for GBC, however, remains unclear.…”