Radiological Downstaging with Neoadjuvant Therapy in Unresectable Gall Bladder Cancer Cases

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. (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.

The predictive value of systemic immune inflammation index for postoperative survival of gallbladder carcinoma patients

“…It has been reported as a prognostic biomarker for various tumors including GBC 32‐34 . Although the optimal cut‐off value is still controversial, the use of CA19‐9 may provide an opportunity to guide personalized neoadjuvant therapy for GBC patients 35 . However, CA19‐9 levels are elevated not only in the case of GBC but also in other cancers and certain inflammatory diseases.…”

Elevation of CA19-9 and CEA is associated with a poor prognosis in patients with resectable gallbladder carcinoma

“…23 Another study demonstrated that neoadjuvant therapy in unresectable GBC resulted in a 15% resectability rate. 24 The use of CEA and CA19-9 might provide opportunity for guiding personalized neoadjuvant therapy in patients with GBC.…”

Gallbladder cancer epidemiology, treatment and survival in Southern Finland – a population-based study

“…In 2019, BILCAP trial suggested that adjuvant capecitabine could offer a survival benefit in patients with biliary tract cancers, including GBC, who had undergone curative-intent surgery [13]. On the other hand, evidence for neoadjuvant therapy is still moderate, and no recommendations have been made [14][15][16][17]. Although current recommendations for GBC's surgical treatment are mostly unanimous [18,19], the benefits of extended cholecystectomy in stages I and IIA are still highly debated [20][21][22].…”