Radiological Downstaging with Neoadjuvant Therapy in Unresectable Gall Bladder Cancer Cases

Agrawal, Sushma; Mohan, Lalit; Mourya, Chandan; Neyaz, Zafar; Saxena, Rajan

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자료유형: 학술저널

저자정보: 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)

저널정보: 아시아태평양암예방학회 Asian Pacific journal of cancer prevention : APJCP Asian Pacific journal of cancer prevention : APJCP 제17권 제4호

발행연도: 2016.1

수록면: 2,137 - 2,140 (4page)

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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.

#Radiologic downstaging #neoadjuvant therapy #unresectable gallbladder cancer

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