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Vergara-Gómez L, Bizama C, Zhong J, Buchegger K, Suárez F, Rosa L, Ili C, Weber H, Obreque J, Espinoza K, Repetto G, Roa JC, Leal P, García P. A Novel Gemcitabine-Resistant Gallbladder Cancer Model Provides Insights into Molecular Changes Occurring during Acquired Resistance. Int J Mol Sci 2023; 24:ijms24087238. [PMID: 37108401 PMCID: PMC10139168 DOI: 10.3390/ijms24087238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Treatment options for advanced gallbladder cancer (GBC) are scarce and usually rely on cytotoxic chemotherapy, but the effectiveness of any regimen is limited and recurrence rates are high. Here, we investigated the molecular mechanisms of acquired resistance in GBC through the development and characterization of two gemcitabine-resistant GBC cell sublines (NOZ GemR and TGBC1 GemR). Morphological changes, cross-resistance, and migratory/invasive capabilities were evaluated. Then, microarray-based transcriptome profiling and quantitative SILAC-based phosphotyrosine proteomic analyses were performed to identify biological processes and signaling pathways dysregulated in gemcitabine-resistant GBC cells. The transcriptome profiling of parental and gemcitabine-resistant cells revealed the dysregulation of protein-coding genes that promote the enrichment of biological processes such as epithelial-to-mesenchymal transition and drug metabolism. On the other hand, the phosphoproteomics analysis of NOZ GemR identified aberrantly dysregulated signaling pathways in resistant cells as well as active kinases, such as ABL1, PDGFRA, and LYN, which could be novel therapeutic targets in GBC. Accordingly, NOZ GemR showed increased sensitivity toward the multikinase inhibitor dasatinib compared to parental cells. Our study describes transcriptome changes and altered signaling pathways occurring in gemcitabine-resistant GBC cells, which greatly expands our understanding of the underlying mechanisms of acquired drug resistance in GBC.
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Affiliation(s)
- Luis Vergara-Gómez
- Biomedicine and Translational Research Laboratory, Centre of Excellence in Translational Medicine and Scientific and Technological Bioresource Nucleus (CEMT-BIOREN), Universidad de La Frontera, Temuco 4810296, Chile
| | - Carolina Bizama
- School of Medicine, Department of Pathology, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
- Center for Cancer Prevention and Control (CECAN), Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Jun Zhong
- Delta Omics Biotechnology, Rockville, MD 20855, USA
| | - Kurt Buchegger
- Department of Basic Sciences, Universidad de La Frontera, Temuco 4810296, Chile
| | - Felipe Suárez
- School of Medicine, Department of Pathology, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Lorena Rosa
- School of Medicine, Department of Pathology, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Carmen Ili
- Laboratory of Integrative Biology (LIBi), Centre of Excellence in Translational Medicine and Scientific and Technological Bioresource Nucleus (CEMT-BIOREN), Universidad de La Frontera, Temuco 4810296, Chile
| | - Helga Weber
- Biomedicine and Translational Research Laboratory, Centre of Excellence in Translational Medicine and Scientific and Technological Bioresource Nucleus (CEMT-BIOREN), Universidad de La Frontera, Temuco 4810296, Chile
| | - Javiera Obreque
- School of Medicine, Department of Pathology, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Karena Espinoza
- Center for Genetics and Genomics, Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago 7610658, Chile
| | - Gabriela Repetto
- Center for Genetics and Genomics, Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago 7610658, Chile
| | - Juan C Roa
- School of Medicine, Department of Pathology, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
- Center for Cancer Prevention and Control (CECAN), Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII), Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Pamela Leal
- Biomedicine and Translational Research Laboratory, Centre of Excellence in Translational Medicine and Scientific and Technological Bioresource Nucleus (CEMT-BIOREN), Universidad de La Frontera, Temuco 4810296, Chile
- Department of Agricultural Sciences and Natural Resources, Faculty of Agricultural and Forestry Science, Universidad de La Frontera, Temuco 4810296, Chile
| | - Patricia García
- School of Medicine, Department of Pathology, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
- Center for Cancer Prevention and Control (CECAN), Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
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Gholami S, Colby S, Horowitz DP, Guthrie KA, Ben-Josef E, El-Khoueiry AB, Blanke CD, Philip PA, Kachnic LA, Ahmad SA, Rocha FG. Adjuvant Chemoradiation in Patients with Lymph Node-Positive Biliary Tract Cancers: Secondary Analysis of a Single-Arm Clinical Trial (SWOG 0809). Ann Surg Oncol 2023; 30:1354-1363. [PMID: 36622529 PMCID: PMC10695673 DOI: 10.1245/s10434-022-12863-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/10/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND SWOG 0809 is the only prospective study of adjuvant chemotherapy followed by chemoradiation focusing on margin status in patients with extrahepatic cholangiocarcinoma (EHCC) and gallbladder cancer (GBCA); however, the effects of adjuvant therapy by nodal status have never been reported in this population. METHODS Patients with resected EHCC and GBCA, stage pT2-4, node-positive (N+) or margin-positive (R1) who completed four cycles of chemotherapy followed by radiotherapy were included. Cox regression was used to compare overall survival (OS), disease-free survival (DFS), local recurrence, and distant metastasis by nodal status. DFS rates were compared with historical data via a one-sample t-test. RESULTS Sixty-nine patients [EHCC, n = 46 (66%); GBCA, n = 23 (33%)] were evaluated, with a median age of 61.7 years and an R0 rate of 66.7% and R1 rate of 33.3%. EHCC versus GBCA was more likely to be N+ (73.9% vs. 47.8%, p = 0.03). Nodal status did not significantly impact OS (hazard ratio [HR] 1.98, 95% confidence interval [CI] 0.86-4.54, p = 0.11) or DFS (HR 1.63, 95% CI 0.77-3.44, p = 0.20). Two-year OS was 70.6% for node-negative (N0) disease and 60.9% for N+ disease, while 2-year DFS was 62.5% for N0 tumors and 49.8% for N+ tumors. N+ versus N0 tumors showed higher rates of distant failure (42.2% vs. 25.0%, p = 0.04). The 2-year DFS rate in N+ tumors was significantly higher than in historical controls (49.8% vs. 29.7%, p = 0.004). CONCLUSIONS Adjuvant therapy is associated with favorable outcome independent of nodal status and may impact local control in N+ patients. These data could serve as a benchmark for future adjuvant trials, including molecular-targeted agents.
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Affiliation(s)
- Sepideh Gholami
- Department of Surgery, University of California, Davis, CA, USA.
| | - Sarah Colby
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - David P Horowitz
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York City, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York City, NY, USA
| | - Katherine A Guthrie
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Edgar Ben-Josef
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Anthony B El-Khoueiry
- Department of Clinical Medicine, University of Southern California, Los Angeles, CA, USA
| | - Charles D Blanke
- SWOG Group Chair's Office, Oregon Health Sciences University, Knight Cancer Institute, Portland, OR, USA
| | - Philip A Philip
- Department of Oncology and Department of Pharmacology, School of Medicine, Wayne State University, Karmanos Cancer Center, Detroit, MI, USA
| | - Lisa A Kachnic
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York City, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York City, NY, USA
| | - Syed A Ahmad
- Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Flavio G Rocha
- Division of Surgical Oncology, Oregon Health Sciences University, Knight Cancer Institute, Portland, OR, USA
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3
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Song J, Kang X, Di Y, Ren G, Wang Y. Associations between external beam radiotherapy and overall survival in patients with gallbladder cancer: A population-based study. Front Public Health 2022; 10:1012142. [PMID: 36311614 PMCID: PMC9614712 DOI: 10.3389/fpubh.2022.1012142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/20/2022] [Indexed: 01/27/2023] Open
Abstract
Background There is a lack of studies regarding radiotherapy (RT) in patients with gallbladder cancer (GBC) on the survival benefit after surgery and nonsurgical treatment. Therefore, this study evaluated the impact of external beam RT on the overall survival (OS) of patients with GBC in a real-world setting. Methods Patients with GBC enrolled from the Surveillance, Epidemiology, and End Results (SEER) database were examined through Kaplan-Meier survival curves and multivariable Cox regression analyses. Results A total of 7,866 patients with GBC were screened for the current analysis, of whom 2,130 (27.1%) did not undergo RT or surgery, 209 (2.7%) underwent RT, 4,511 (57.3%) underwent surgery, and 1,016 (12.9%) underwent both RT and surgery. The median OS times were 4 months, 8 months, 16 months, and 22 months (p < 0.0001). OS was significantly different between adjuvant RT (p = 0.0002) and palliative RT (p < 0.0001). Multifactorial analysis (controlling for age, sex, year of diagnosis, marital status, race, grade, and stage) showed that both adjuvant RT (surgery and adjuvant RT vs. surgery alone; HR, 0.75; 95% CI, 0.69-0.82, p < 0.001) and palliative RT (RT alone vs. no treatment; HR, 0.80; 95% CI, 0.69-0.92, p = 0.003) had a significant impact on patient OS. The results remained stable following sensitivity analyses. Conclusion The study results indicate that adjuvant and palliative radiation treatment was associated with a survival benefit. GBC patients can derive a survival benefit from external beam RT.
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Affiliation(s)
- Jiazhao Song
- Graduate School of Hebei North University, Zhangjiakou, China,Department of Radiotherapy, Air Force Medical Center PLA, Beijing, China
| | - Xiaoli Kang
- Department of Radiotherapy, Air Force Medical Center PLA, Beijing, China
| | - Yupeng Di
- Department of Radiotherapy, Air Force Medical Center PLA, Beijing, China
| | - Gang Ren
- Department of Radiotherapy, Air Force Medical Center PLA, Beijing, China
| | - Yingjie Wang
- Department of Radiotherapy, Air Force Medical Center PLA, Beijing, China,*Correspondence: Yingjie Wang
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Kumar D, Kiran NM, Khosla D. Reviewing the potential role of radiation therapy in gallbladder cancer: an update. Radiat Oncol J 2022; 40:1-8. [PMID: 35368195 PMCID: PMC8984131 DOI: 10.3857/roj.2021.00717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Gallbladder cancer is a highly malignant disease with a poor prognosis. It is the most common cancer of the biliary tract pathway. Although surgery remains the treatment of choice for early-stage disease, majority of the patients presents in locally advanced, unresectable and metastatic stage of the disease. Radiotherapy and chemotherapy thus form an integral part of management for these locally advanced staged patients. The role of radiation though has been advocated in gallbladder cancer, majorly in the adjuvant setting, its role in neoadjuvant and palliative settings remains in an evolving phase. The article thus aims to review and update the existing literature regarding the role of radiation therapy in gallbladder cancer.
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Affiliation(s)
- Divyesh Kumar
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Correspondence: Divyesh Kumar Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. Tel: +91-172-2756284 E-mail:
| | - Nali Muni Kiran
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Khosla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Choudhary S, Gupta N, Verma CP, Das A, Aggarwal LM, Tewari M, Mandal A, Asthana AK. Influence of adjuvant therapy on pattern of failure and survival in curatively resected gallbladder carcinoma. J Cancer Res Ther 2021; 17:1064-1068. [PMID: 34528565 DOI: 10.4103/jcrt.jcrt_550_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Purpose The study was done to evaluate the role of adjuvant therapy in curatively resected Stage II and III gallbladder carcinoma (GBC). Materials and Methods This was a retrospective analysis of patients of GBC registered between 2008 and 2017 in outpatient department of a tertiary cancer hospital in India. Patients who had any of the following adjuvant treatment after radical surgery: (a) external beam radiotherapy (RT) alone, (b) chemotherapy (CT) alone, and (c) RT with CT (CRT) were considered for the study. Results A total of fifty patients could meet the selection criteria. It was seen that seven patients were treated with RT, 20 with CT, and 23 with CRT. Median follow-up for patients who were alive was 26.7 months. Nineteen patients had locoregional failure while eight had distant failure. Patients treated with CRT had a significantly better mean overall survival compared to those treated with RT or CT (44.0 months, 12.5 months, and 15.1 months, respectively; P = 0.003). Similarly, mean disease-free survival was superior in CRT arm compared to RT and CT arms (43.6 months, 9.6 months, and 12.4 months, respectively; P = 0.002). Conclusions Adjuvant CRT had better survival outcome compared to patients treated with either RT or CT with Stage II and III disease after curative cholecystectomy.
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Affiliation(s)
- Sunil Choudhary
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Neha Gupta
- Department of Radiotherapy, Apex Cancer Institute, Apex Hospital, Varanasi, Uttar Pradesh, India
| | - Chandra Prakash Verma
- Department of Radiotherapy, Apex Cancer Institute, Apex Hospital, Varanasi, Uttar Pradesh, India
| | - Avipsa Das
- Department of Radiation Oncology, Tata Memorial Centre, Kolkata, West Bengal, India
| | - Lalit Mohan Aggarwal
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mallika Tewari
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Abhijit Mandal
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anupam Kumar Asthana
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Radical Resection Versus Simple Cholecystectomy for Gallbladder Carcinoma: A Systematic Review and Meta-analysis. Surg Laparosc Endosc Percutan Tech 2021; 30:381-387. [PMID: 32287113 DOI: 10.1097/sle.0000000000000789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The goal of this study was to review relevant randomized controlled trials or case-control studies to determine radical resection compared with simple cholecystectomy for gallbladder carcinoma. METHODS Using appropriate keywords, we identified relevant studies using PubMed, the Cochrane Library, and Embase. Key pertinent sources in the literature were also reviewed, and all articles published through September 2019 were considered for inclusion. For each study, we assessed odds ratios, mean difference, and 95% confidence interval (CI) to assess and synthesize outcomes. RESULTS We included 19 studies with a total of 1791 patients in the radical resection group and 3014 in the simple cholecystectomy group. Compared with simple cholecystectomy, radical resection significantly improved the 5-year disease-free survival rate [relative risk (RR): 1.36, 95% CI: 1.02-1.81], the 1-year overall survival (OS) rate (RR: 1.27, 95% CI: 1.04-1.54), and the 3-year OS rate (RR: 1.71, 95% CI: 1.02-2.85). However, there was no significant difference in the recurrence rate (RR: 1.04, 95% CI: 0.87-1.23), and in the 5-year OS rate (RR: 1.05, 95% CI: 0.92-1.19) between the 2 groups. CONCLUSION Compared with simple cholecystectomy, radical resection has advantages in improving the 5-year disease-free survival rate, and the 1- and 3-year OS rate of gallbladder carcinoma patients.
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Gkika E, Hawkins MA, Grosu AL, Brunner TB. The Evolving Role of Radiation Therapy in the Treatment of Biliary Tract Cancer. Front Oncol 2021; 10:604387. [PMID: 33381458 PMCID: PMC7768034 DOI: 10.3389/fonc.2020.604387] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/04/2020] [Indexed: 12/13/2022] Open
Abstract
Biliary tract cancers (BTC) are a disease entity comprising diverse epithelial tumors, which are categorized according to their anatomical location as intrahepatic (iCCA), perihilar (pCCA), distal (dCCA) cholangiocarcinomas, and gallbladder carcinomas (GBC), with distinct epidemiology, biology, and prognosis. Complete surgical resection is the mainstay in operable BTC as it is the only potentially curative treatment option. Nevertheless, even after curative (R0) resection, the 5-year survival rate ranges between 20 and 40% and the disease free survival rates (DFS) is approximately 48–65% after one year and 23–35% after three years without adjuvant treatment. Improvements in adjuvant chemotherapy have improved the DFS, but the role of adjuvant radiotherapy is unclear. On the other hand, more than 50% of the patients present with unresectable disease at the time of diagnosis, which limits the prognosis to a few months without treatment. Herein, we review the role of radiotherapy in the treatment of cholangiocarcinoma in the curative and palliative setting.
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Affiliation(s)
- Eleni Gkika
- Department of Radiation Oncology, University Medical Centre Freiburg, Freiburg, Germany
| | - Maria A Hawkins
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University Medical Centre Freiburg, Freiburg, Germany
| | - Thomas B Brunner
- Department of Radiation Oncology, University of Magdeburg, Magdeburg, Germany
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Dosimetric comparison of constant dose rate volumetric modulated arc therapy (CDR-VMAT) and intensity-modulated radiation therapy (IMRT) for gallbladder cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920001132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim:
To study the feasibility of constant dose rate volumetric modulated arc therapy (CDR-VMAT) in radiotherapy for gallbladder cancer by comparing dosimetric parameter suggested by International Commission on Radiation Units and Measurements-83 (ICRU-83) with step and shoot intensity-modulated radiation therapy (SS IMRT).
Methods:
For this study, we selected 21 post-operative gallbladder cancer patients, which were treated with the IMRT technique from 2016 to 2019. For each patient, we generated SS IMRT plan and CDR-VMAT plan and were dosimetrically compared by parameters suggested by ICRU-83 for PTV. Homogeneity Index (HI) and Conformity Index (CI) were also calculated. For evaluation of Organ at Risk (OAR), we compared the mean doses, volume doses to the right kidney, left kidney, both kidneys combined, liver and max dose to the spinal cord. Monitor units (MUs) and treatment delivery time were also compared.
Results:
On comparing, we found that CDR-VMAT plans were highly conformed as CI and PCI (CI define by Paddick) were found more (0·98 ± 0·01 vs. 0·97 ± 0·03 and 0·86 ± 0·05 vs. 0·85 ± 0·05) than IMRT plans but not statistically significant. Better dose HI was found for IMRT plans with statistical significant difference (p < 0·001). The tumour coverage was found similar 98·24% and 97·83% for SS IMRT and CDR-VMAT, respectively. For D2%, the maximum dose to PTV was significantly lower in IMRT (p = 0·001). D50% and mean dose to PTV were also comparable to IMRT with no statistically significant difference. The OAR parameters were comparable in both the techniques. The mean doses and volume doses V10, V20 and V30 to the right kidney, left kidney and liver were also comparable with no significant difference (p > 0·05) was noted among them. However, the maximum dose to the spinal cord was significantly less in CDR-VMAT (21·1 Gy vs. 25·1Gy) than SS IMRT with p = 0·006. More MUs were associated with the CDR-VMAT technique, but shorter treatment delivery time than the IMRT technique.
Conclusions:
On dosimetric comparison of two treatment techniques, we conclude that CDR-VMAT can be a valid option in radiotherapy as it achieved highly conformed dose distribution, comparable tumour coverage and OAR sparing as IMRT technique for gallbladder cancer.
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Kapoor R, Periasamy K, Gupta R, Yadav A, Khosla D. Real world clinical outcomes of adjuvant sequential chemoradiation in patients with gallbladder carcinomas with poor performance status. Radiat Oncol J 2020; 38:262-269. [PMID: 33389981 PMCID: PMC10652062 DOI: 10.3857/roj.2020.00626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The purpose of the study is to analyze the overall survival, relapse-free survival, and relapse patterns of adjuvant sequential chemoradiation for gallbladder cancers after curative resection in patients with poor performance status. MATERIALS AND METHODS We retrospectively reviewed clinical records of gallbladder patients with pathologic stage T2-4 or node positivity treated with sequential chemoradiation at our institute between January 2015 and January 2019. Sequential chemoradiotherapy protocol consisted of six cycles of gemcitabine 1,000 mg/m2 and oxaliplatin 100 mg/m2 administered every 2 weekly and postoperative radiation therapy (45 Gy in 25 fractions over 5 weeks) by three-dimensional conformal technique. RESULTS A total of 36 patients were included. The median overall survival and relapse-free survival was 26 months (95% confidence interval [CI], 21.4-30.5) and 21 months (95% CI, 11.8-30.1), respectively. The 2-year overall and relapse-free survival rates were 55.1% (95% CI, 37.9%-72.3%) and 44.7% (95% CI, 27.5%-61.9%), respectively. Locoregional, systemic, and combined recurrence were noted in 2 (5.5%), 14 (38.8%), and 3 (8.3%) patients, respectively. On univariate analysis, tumour grading significantly influenced relapse free survival; nodal stage and overall stage demonstrated a statistically significant influence on overall survival (p < 0.05) with a trend towards significance for lymphovascular invasion. On multivariate analysis, no significant factors were found. Grade 3 and 4 haematological adverse events were observed only in 2 (5.5%) with chemotherapy. No grade 3 and 4 adverse events were observed due to radiation therapy. CONCLUSION Sequential chemoradiation is feasible and tolerable with acceptable efficacy in the adjuvant setting in patients unfit for concurrent chemoradiotherapy.
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Affiliation(s)
- Rakesh Kapoor
- Department of Radiotherapy, Homi Bhabha Cancer Hospital and Research Center, Mullanpur & Sangrur, India
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kannan Periasamy
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun Yadav
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Divya Khosla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Gamboa AC, Maithel SK. The Landmark Series: Gallbladder Cancer. Ann Surg Oncol 2020; 27:2846-2858. [PMID: 32474816 DOI: 10.1245/s10434-020-08654-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Indexed: 12/13/2022]
Abstract
Given the rarity of gallbladder carcinoma, level I evidence to guide the multimodal treatment of this disease is lacking. Since 2010, four randomized phase III clinical trials including ABC-02, PRODIGE-12/ACCORD-18, BILCAP, and BCAT, and a single-arm phase II trial (SWOG0809) have been reported on the use of adjuvant strategies for biliary malignancies. These trials have led to the recommendation that patients with resected biliary tract cancer should be offered adjuvant capecitabine chemotherapy and those with R1 margins could be considered for chemoradiotherapy. Because there is no level I evidence to guide neoadjuvant therapy or surgical management, current consensus is based on strong retrospective data. The following review summarizes available trials and highlights the best available evidence that form the basis of consensus statements for the multimodal management of gallbladder carcinoma.
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Affiliation(s)
- Adriana C Gamboa
- Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, GA, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
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Lamarca A, Edeline J, McNamara MG, Hubner RA, Nagino M, Bridgewater J, Primrose J, Valle JW. Current standards and future perspectives in adjuvant treatment for biliary tract cancers. Cancer Treat Rev 2020; 84:101936. [PMID: 31986437 DOI: 10.1016/j.ctrv.2019.101936] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 02/06/2023]
Abstract
Biliary tract cancer, including cholangiocarcinoma (CCA) and gallbladder cancer (GBC) are rare tumours with a rising incidence. Prognosis is poor, since most patients are diagnosed with advanced disease. Only ~20% of patients are diagnosed with early-stage disease, suitable for curative surgery. Despite surgery performed with potentially-curative intent, relapse rates are high, with around 60-70% of patients expected to have disease recurrence. Most relapses occur in the form of distant metastases, with a predominance of liver spread. In view of high tumour recurrence, adjuvant strategies have been explored for many years, in the form of radiotherapy, chemo-radiotherapy and chemotherapy. Historically, few randomised trials were available, which included a variety of additional tumours (e.g. pancreatic and ampullary tumours); most evidence relied on phase II and retrospective studies, with no high-quality evidence available to define the real benefit derived from adjuvant strategies. Since 2017, three randomised phase III clinical trials have been reported; all recruited patients with resected biliary tract cancer (CCA and GBC) who were randomised to observation alone, or chemotherapy in the form of gemcitabine (BCAT study; included patients diagnosed with extrahepatic CCA only), gemcitabine and oxaliplatin (PRODIGE-12/ACCORD-18; included patients diagnosed with CCA and GBC) or capecitabine (BILCAP; included patients diagnosed with CCA and GBC). While gemcitabine-based chemotherapy failed to show an impact on patient outcome (relapse-free survival (RFS) or overall survival (OS)), the BILCAP study showed a benefit from adjuvant capecitabine in terms of OS (pre-planned sensitivity analysis in the intention-to-treat population and in the per-protocol analysis), with confirmed benefit in terms of RFS. Based on the BILCAP trial, international guidelines recommend adjuvant capecitabine for a period of six months following potentially curative resection of CCA as the current standard of care for resected CCA and GBC. However, BILCAP failed to show OS benefit in the intention-to-treat (non-sensitivity analysis) population (primary end-point), and this finding, as well as some inconsistencies between studies has been criticised and has led to confusion in the biliary tract cancer medical community. This review summarises the adjuvant field in biliary tract cancer, with evidence before and after 2017, and comparison between the latest randomised phase III studies. Potential explanations are presented for differential findings, and future steps are explored.
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Affiliation(s)
- Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Julien Edeline
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - Mairéad G McNamara
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Richard A Hubner
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Masato Nagino
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - John Bridgewater
- Department of Medical Oncology, UCL Cancer Institute, London, United Kingdom
| | - John Primrose
- Department of Surgery, University of Southampton, Southampton, United Kingdom
| | - Juan W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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Manterola C, Duque G, Grande L, de Aretxabala X, Conejeros R, Otzen T, García N. A systematic review of the effectiveness of adjuvant therapy for patients with gallbladder cancer. HPB (Oxford) 2019; 21:1427-1435. [PMID: 30922845 DOI: 10.1016/j.hpb.2019.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/15/2019] [Accepted: 02/26/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Equipoise exists regarding the benefit of adjuvant therapy (AT) in patients with gallbladder cancer (GBC). The aim of this study was to critically review the available evidence for the effectiveness of AT in patients with GBC following surgery with curative intent. METHODS A systematic review was performed. Relevant studies were identified from Trip Database, BIREME-BVS, SciELO, Cochrane Central Register, WoS, MEDLINE, EMBASE and SCOPUS. Adjuvant therapies considered included chemotherapy, chemoradiotherapy, and radiotherapy. The primary outcome was overall survival (OS). Subgorup analysis of patients with positive lymph node disease (PLND), positive surgical margin (PSM), or advanced stage (AS) were performed. RESULTS 748 related articles were identified; 27 met the selection criteria (3 systematic reviews and 24 observational studies). Evidence provided was moderate, poor and very poor for chemotherapy, chemoradiotherapy, and radiotherapy. Existing evidence is not robust, but suggests certain benefits with AT in improving OS, especially in patients with PLND, PSM and AS. CONCLUSION Results do not provide strong evidence that AT is effective in patients who undergo resection for GBC. Subgroups of PLND and PSM may have a survival advantage. Future studies with appropriate internal validity and adequate number of patients are required to better answer this question.
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Affiliation(s)
- Carlos Manterola
- Department of Surgery, Universidad de La Frontera, Chile; Center of Excellence in Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Chile; PhD Program in Medical Sciences, Universidad de La Frontera, Chile.
| | - Galo Duque
- PhD Program in Medical Sciences, Universidad de La Frontera, Chile; Faculty of Medicine, Universidad del Azuay, Cuenca, Ecuador
| | - Luis Grande
- Department of Surgery, Hospital Clínico del Mar, Barcelona, Spain
| | | | | | - Tamara Otzen
- Center of Excellence in Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Chile; PhD Program in Medical Sciences, Universidad de La Frontera, Chile
| | - Nayely García
- PhD Program in Medical Sciences, Universidad de La Frontera, Chile
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Fareed MM, DeMora L, Esnaola NF, Denlinger CS, Karachristos A, Ross EE, Hoffman J, Meyer JE. Concurrent chemoradiation for resected gall bladder cancers and cholangiocarcinomas. J Gastrointest Oncol 2018; 9:762-768. [PMID: 30151273 DOI: 10.21037/jgo.2018.05.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Gallbladder cancer (GBC) and cholangiocarcinoma (CCA) are rare entities with relatively poor prognoses. We compared treatment outcomes of definitive resection with or without neoadjuvant therapy in GBC and CCA patients. Methods All non-metastatic GBC and CCA patients at a single institution who underwent definitive resection from 1992-2016 were analyzed. We compared overall survival (OS), locoregional failure (LRF) and distant failure (DF) in patients who received neoadjuvant therapy (chemotherapy and/or radiation) versus those who did not receive neoadjuvant treatment. OS was analyzed using the Kaplan-Meier method and log rank tests. Cox proportional hazard models were used to analyze time to recurrence. Results Out of 128 patients, 90 had GBC and 38 had CCA, 25 patients (27%) among GBC and 8 patients (21%) with CCA were T3, T4 or node positive. Overall, 52 (40%) GBC and 25 (20%) CCA patients received neoadjuvant treatment, chemotherapy alone 60 patients (47%) or radiation with or without chemotherapy 17 patients (13%). Chemotherapy was single agent in 44 patients (34%) and multi-agent in 25 (20%). The median OS for GBC patients was 3.1 years with 2.6 years for no neoadjuvant group and 3.1 years for neoadjuvant group (P=0.6786). Median OS was 2.6 years for CCA patients, 3.6 years for no neoadjuvant therapy versus 2.0 years for neoadjuvant group (P=0.1613). There was a trend towards increased DF in patients with CCA and GBC receiving neoadjuvant therapy: HR 2.74, 95% CI, 0.73-10.3, P=0.14 and 0.92, 95% CI, 0.44-1.93, P=0.82 respectively. The hazard ratio for time to LRF in CCA patients receiving neoadjuvant treatment was 3.17, 95% CI, 0.62-16.31, P=0.16 whereas HR was 0.15, 95% CI, 0.10-1.76, P=0.23 for GBC patients. Among GBC patients, the pattern of first failure was locoregional in 8 (10%) having 3 LRF in neoadjuvant group (2 with chemotherapy, 1 with CRT, 0 with RT alone) as compared to 5 in adjuvant group. Among 28 (35%) patients with DF first, 15 patients received neoadjuvant therapy versus 13 patients in non-neoadjuvant group. In CCA patients, LRF occurred first in 6 patients receiving neoadjuvant treatment (3 with chemotherapy, 1 with CRT, 2 with RT alone) as compared to 2 patients who were treated with non-neoadjuvant CRT. DF was the first site of failure in 9 patients treated with neoadjuvant CRT (8 with chemotherapy, 0 with CRT and 1 with RT alone) as compared to 4 patients without neoadjuvant treatment. Conclusions In this retrospective data set, a trend towards better survival was seen in adjuvantly treated CCA patients, but not in GBC patients. Recurrence patterns also appear different among the two, which might be attributed to treatment modality used, patient selection or unmeasured factors. Keywords Gallbladder cancer (GBC); cholangiocarcinoma (CCA); neoadjuvant; resection; chemoradiation; chemotherapy.
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Affiliation(s)
- Muhammad M Fareed
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Lyudmila DeMora
- Department of Biostatistics, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - Nestor F Esnaola
- Department of Surgical Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - Crystal S Denlinger
- Department of Hematology/Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - Andreas Karachristos
- Department of Surgical Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - Eric E Ross
- Department of Biostatistics, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - John Hoffman
- Department of Surgical Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
| | - Joshua E Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, PA, USA
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Gu B, Qian L, Yu H, Hu J, Wang Q, Shan J, Shi L, Liu H, Yang Q, Liang X, Cai X, Sun X. Concurrent Chemoradiotherapy in Curatively Resected Gallbladder Carcinoma: A Propensity Score–Matched Analysis. Int J Radiat Oncol Biol Phys 2018; 100:138-145. [DOI: 10.1016/j.ijrobp.2017.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/24/2017] [Accepted: 09/13/2017] [Indexed: 12/13/2022]
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15
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Conditional survival in patients with gallbladder cancer. CHINESE JOURNAL OF CANCER 2017; 36:85. [PMID: 29084608 PMCID: PMC5663056 DOI: 10.1186/s40880-017-0252-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 10/19/2017] [Indexed: 12/18/2022]
Abstract
Background Conditional survival (CS) has been established as a clinically relevant prognostic factor for cancer survivors, and the CS in gallbladder (GB) cancer has not yet been fully evaluated. In this study, we evaluated the cancer-specific CS rate and cancer-specific survival (CSS) rate in patients with GB cancer at multiple time points and investigated prognostic factors which affect cancer-specific CS rate to provide more accurate survival information. Methods Between 2004 and 2013, a total of 9760 patients with GB cancer were identified from the Surveillance, Epidemiology, and End Results (SEER) data. The 3-year cancer-specific CS rate was calculated using the covariate-adjusted survival function in the Cox model for each year since diagnosis, and the results were analyzed together with the adjusted CSS rates at the same time points. Cox proportional hazards regression was performed to ascertain the individual contribution of factors associated with CSS rate at diagnosis and cancer-specific CS rates at 1, 3, and 5 years after diagnosis. Results The adjusted 5-year CSS rate was 26.1%. The adjusted 3-year cancer-specific CS rates at 1, 2, 3, 4, and 5 years after diagnosis were 55.5, 72.2, 81.5, 86.8, and 90.5%, respectively. At the time of diagnosis, age, race, histology, grade, T, N, and M categories, surgery, radiotherapy, insurance status, and marriage status were significant prognostic factors of CSS. Five years after diagnosis, however, T and M categories were significant prognostic factors for survivors (P = 0.007 and P = 0.009, respectively), whereas surgery and radiotherapy were not. Conclusions T and M categories were significant prognostic factors even 5 years after the initial diagnosis, whereas local treatments at the time of diagnosis were not, suggesting that patients with GB cancer at high risks might need further adjuvant therapy after primary treatments. The combined analysis of CSS and cancer-specific CS rates offered more accurate survival information for patients who have already survived a certain period of time after diagnosis.
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Nodal areas of potential geographic error in adjuvant radiotherapy for biliary tract cancer. Radiother Oncol 2017; 125:365-373. [PMID: 29033254 DOI: 10.1016/j.radonc.2017.09.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 09/17/2017] [Accepted: 09/23/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE To determine the areas of potential geographic error in adjuvant radiotherapy (RT) for biliary-tract cancer (BTC) by comparing pathological-surgical data on the pattern of nodal spread with the extent of elective nodal CTV used in published RT studies in this setting. MATERIAL/METHODS A literature search was performed to select articles on: 1/adjuvant RT for BTC, that provided information on the lymph node stations (LNS) included in the CTV; 2/the pathological-surgical data on the patterns of nodal involvement/recurrence in BTC. Risk of nodal involvement/recurrence and frequency of inclusion in the CTV in RT studies for each of the LNS were compared to determine the areas of potential geographic misses and unnecessary irradiation, separately for intrahepatic cholangiocarcinoma (IHC), extrahepatic cholangiocarcinoma (EHC) and gallbladder-cancer (GBC). RESULTS Areas of potential geographic misses include: for right IHC: paraaortic and superior mesenteric artery (SMA) LNS; for left or hilar IHC: left gastric, lesser gastric curvature, paraaortic, and SMA LNS; for proximal EHC: paraaortic LNS; for middle EHC: paraaortic and SMA LNS; for distal EHC: paraaortic, SMA, and anterior pancreatico-duodenal LNS; for GBC: paraaortic, SMA, and posterior pancreatico-duodenal LNS. Celiac-LNS is unnecessarily irradiated for middle/distal EHC. CONCLUSIONS In view of discrepancies between pathological-surgical data and the CTVs used in common practice, there is an obvious need for international consensus guidelines.
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17
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Kim Y, Amini N, Wilson A, Margonis GA, Ethun CG, Poultsides G, Tran T, Idrees K, Isom CA, Fields RC, Krasnick B, Weber SM, Salem A, Martin RCG, Scoggins C, Shen P, Mogal HD, Schmidt C, Beal E, Hatzaras I, Shenoy R, Cardona K, Maithel SK, Pawlik TM. Impact of Chemotherapy and External-Beam Radiation Therapy on Outcomes among Patients with Resected Gallbladder Cancer: A Multi-institutional Analysis. Ann Surg Oncol 2016; 23:2998-3008. [PMID: 27169772 DOI: 10.1245/s10434-016-5262-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Use of adjuvant chemotherapy (CTx) and chemoradiation therapy (cXRT) for the treatment of gallbladder cancer (GBC) remains varied. We sought to define the utilization and effect of adjuvant therapy for patients with GBC. METHODS Using a multi-institutional national database, 291 patients with GBC who underwent curative-intent resection between 2000 and 2015 were included. Patients with metastasis or an R2 margin were excluded. RESULTS Median patient age was 66.6 years. Most patients had a T2 (46.2 %) or T3 (38.6 %) lesion, and 37.8 % of patients had lymph node (LN) metastasis. A total of 186 (63.9 %) patients underwent surgery alone, 61 (21.0 %) received CTx, and 44 (15.1 %) patients received cXRT. On multivariable analysis, factors associated with worse overall survival (OS) included T3/T4 stage [hazard ratio (HR) 1.82], LN-metastasis (HR 1.84), lymphovascular invasion (HR 2.02), perineural invasion (HR 1.42), and R1 surgical margin status (HR 2.06); all P < 0.05). In contrast, receipt of CTx/cXRT was associated with improved OS (CTx, HR 0.38; cXRT, HR 0.26; P < 0.001) compared with surgery alone. Similar results were observed for disease-free survival (DFS) (CTx, HR 0.61; cXRT, HR 0.43; P < 0.05). Of note, only patients with high-risk features, such as AJCC T3/T4 stage (HR 0.41), LN metastasis (HR 0.45), and R1 disease (HR 0.21) (all P < 0.05) derived an OS benefit from CTx/cXRT. CONCLUSIONS Adjuvant CTx/cXRT was utilized in 36 % of patients undergoing curative-intent resection for GBC. After adjusted analyses, CTx/cXRT were independently associated with improved long-term outcomes, but the benefit was isolated to only patients with high-risk characteristics.
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Affiliation(s)
- Yuhree Kim
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Neda Amini
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ana Wilson
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Georgios A Margonis
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Cecilia G Ethun
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - George Poultsides
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Thuy Tran
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Kamran Idrees
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chelsea A Isom
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Bradley Krasnick
- Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Sharon M Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ahmed Salem
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Robert C G Martin
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Charles Scoggins
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Perry Shen
- Department of Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Harveshp D Mogal
- Department of Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Carl Schmidt
- Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Eliza Beal
- Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Rivfka Shenoy
- Department of Surgery, New York University, New York, NY, USA
| | - Kenneth Cardona
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
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Wang J, Narang AK, Sugar EA, Luber B, Rosati LM, Hsu CC, Fuller CD, Pawlik TM, Miller RC, Czito BG, Tuli R, Crane CH, Ben-Josef E, Thomas CR, Herman JM. Evaluation of Adjuvant Radiation Therapy for Resected Gallbladder Carcinoma: A Multi-institutional Experience. Ann Surg Oncol 2015; 22 Suppl 3:S1100-S1106. [PMID: 26224402 PMCID: PMC9671536 DOI: 10.1245/s10434-015-4685-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Indexed: 08/10/2023]
Abstract
PURPOSE The role of adjuvant radiation for gallbladder carcinoma (GBC) is uncertain. We combine the experience of six National Cancer Institute-designated cancer centers to explore the impact of adjuvant radiation following oncologic resection of GBC. METHODS Patients who underwent extended surgery for GBC at Johns Hopkins, Mayo Clinic, Duke University, Oregon Health & Science University, University of Michigan, and University of Texas MD Anderson between 1985 and 2008 were reviewed. Patients with metastatic disease at surgery, gross residual disease, or missing pathologic information were excluded. RESULTS Of the 112 patients identified, 61 % received adjuvant radiation, 93 % of whom received concurrent chemotherapy. Median follow-up of surviving patients was 47.3 (range 2.2-167.7) months. Patients who received adjuvant radiation had a higher rate of advanced T-stage (57 vs. 16 %, p < 0.01), lymph node involvement (63 vs. 18 %, p < 0.01), and positive microscopic margins (37 vs. 9 %, p < 0.01) compared with patients managed with surgery alone, but overall survival (OS) was comparable between the two cohorts (5-year OS: 49.7 vs. 52.5 %, p = 0.20). Lymph node involvement had the strongest association with poor OS (p < 0.01). Adjuvant radiation was associated with decreased isolated local failure (hazard ratio 0.17, 95 % confidence interval 0.05-0.63, p = 0.01). However, 71 % of recurrences included distant failure. CONCLUSIONS Following oncologic resection for GBC, adjuvant radiation may offer improved local control compared with observation. The benefit of adjuvant radiation beyond chemotherapy alone should therefore be explored. Certainly, the high rate of distant failure highlights the need for more effective systemic therapy.
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Affiliation(s)
| | - Amol K Narang
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth A Sugar
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brandon Luber
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lauren M Rosati
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles C Hsu
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- San Francisco School of Medicine, University of California, San Francisco, CA, USA
| | - Clifton D Fuller
- MD Anderson Cancer Center, Houston, TX, USA
- Uinversity of Texas Health Science Center, San Antonio, TX, USA
| | - Timothy M Pawlik
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Richard Tuli
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Edgar Ben-Josef
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Charles R Thomas
- Uinversity of Texas Health Science Center, San Antonio, TX, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Joseph M Herman
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Mallick S, Benson R, Julka PK, Rath GK. Adjuvant chemoradiotherapy for squamous cell carcinoma of gallbladder. J Gastrointest Cancer 2015; 45 Suppl 1:237-40. [PMID: 25119385 DOI: 10.1007/s12029-014-9641-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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20
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Choudhary S, Asthana AK. Impact of Adjuvant Therapy on Survival in Curatively Resected Gallbladder Carcinoma. J Clin Diagn Res 2015; 9:XC01-XC04. [PMID: 26500994 DOI: 10.7860/jcdr/2015/15113.6436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/15/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Gallbladder carcinoma (GBC) has the propensity to fail at loco-regional (LR) and distant sites despite aggressive radical surgery. Adjuvant therapy in the form of radiotherapy (RT), systemic chemotherapy (CT) and chemoradiation (CRT) is the usual practice. Due to rarity of this disease, there is limited evidence to suggest the type of adjuvant treatment which should be offered to the patients. AIM The study was conducted to evaluate the impact of adjuvant treatment on curatively resected GBC patients. SETTINGS AND DESIGN Histological proven patients of GBC registered between June, 2008 and July, 2014 were identified from our hospital database and retrospective analysis was done. MATERIALS AND METHODS Patients of GBC who had curative resection followed by adjuvant treatment as RT alone, CT alone or CRT were included in the study. STATISTICAL ANALYSIS Adverse prognostic factors and the effect of adjuvant treatment on overall survival (OS) and disease free survival (DFS) were evaluated using Cox Regression Method and Kaplan Meier plot. RESULTS We identified 33 patients of which 23 were Stage I or II disease (Early disease) and the remaining 10 were Stage III or IV disease (Advanced disease). All except one patient had adenocarcinoma. A total of 5 patients were treated with RT alone while 16 patients received CT alone. The remaining 12 patients were treated with CRT. Median follow-up period was 8.5 months. At analysis 4 were alive while the remaining 29 were dead due to disease. With regard to "Early disease" patients who had RT alone, CT alone and CRT, the median OS was 22.3, 10.3 and 15.2 months respectively (p = .440). Cohort of patients with "Advanced disease" who were treated with CT alone and CRT the median OS was 7.5 and 7.0 months respectively (p = .643). On multivariate analysis none of the prognostic factors had an adverse impact on survival. CONCLUSION The impact of adjuvant treatment in the form of RT, CT or CRT after curative resection in GBC patients was seen in terms of improved survival but was not statistically significant.
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Affiliation(s)
- Sunil Choudhary
- Assistant Professor, Department of Radiotherapy & Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University , Varanasi, India
| | - Anupam Kumar Asthana
- Professor, Department of Radiotherapy & Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University , Varanasi, India
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Zhang P, Guo Z, Wu Y, Hu R, Du J, He X, Jiao X, Zhu X. Histone Deacetylase Inhibitors Inhibit the Proliferation of Gallbladder Carcinoma Cells by Suppressing AKT/mTOR Signaling. PLoS One 2015; 10:e0136193. [PMID: 26287365 PMCID: PMC4542213 DOI: 10.1371/journal.pone.0136193] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 07/31/2015] [Indexed: 12/18/2022] Open
Abstract
Gallbladder carcinoma is an aggressive malignancy with high mortality mainly due to the limited potential for curative resection and its resistance to chemotherapeutic agents. Here, we show that the histone deacetylase inhibitors (HDACIs) trichostatin-A (TSA) and suberoylanilide hydroxamic acid (SAHA) reduce the proliferation and induce apoptosis of gallbladder carcinoma cells by suppressing the AKT/mammalian target of rapamycin (mTOR) signaling. Gallbladder carcinoma SGC-996 cells were treated with different concentrations of TSA and SAHA for different lengths of time. Cell proliferation and morphology were assessed with MTT assay and microscopy, respectively. Cell cycle distribution and cell apoptosis were analyzed with flow cytometry. Western blotting was used to detect the proteins related to apoptosis, cell cycle, and the AKT/mTOR signaling pathway. Our data showed that TSA and SAHA reduced SGC-996 cell viability and arrested cell cycle at the G1 phase in a dose- and time-dependent manner. TSA and SAHA promoted apoptosis of SGC-996 cells, down-regulated the expression of cyclin D1, c-Myc and Bmi1, and decreased the phosphorylation of AKT, mTOR p70S6K1, S6 and 4E-BP1. Additionally, the mTOR inhibitor rapamycin further reduced the cell viability of TSA- and SAHA-treated SGC-996 cells and the phosphorylation of mTOR, whereas the mTOR activator 1,2-dioctanoyl-sn-glycero-3-phosphate (C8-PA) exerted the opposite influence. Our results demonstrate that histone deacetylase inhibitors (HDACIs) suppress the proliferation of gallbladder carcinoma cell via inhibition of AKT/mTOR signaling. These findings offer a mechanistic rationale for the application of HDACIs in gallbladder carcinoma treatment.
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Affiliation(s)
- Peng Zhang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiyong Guo
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Wu
- Department of Biostatistics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ronglin Hu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Du
- Department of Microbial and Biochemical Pharmacy, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
| | - Xiaoshun He
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xingyuan Jiao
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- * E-mail: (XJ); (XZ)
| | - Xiaofeng Zhu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- * E-mail: (XJ); (XZ)
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Adjuvant radiotherapy in the treatment of gall bladder carcinoma: What is the current evidence. J Egypt Natl Canc Inst 2015; 28:1-6. [PMID: 26265290 DOI: 10.1016/j.jnci.2015.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/10/2015] [Accepted: 07/11/2015] [Indexed: 01/07/2023] Open
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.
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Ben-Josef E, Guthrie KA, El-Khoueiry AB, Corless CL, Zalupski MM, Lowy AM, Thomas CR, Alberts SR, Dawson LA, Micetich KC, Thomas MB, Siegel AB, Blanke CD. SWOG S0809: A Phase II Intergroup Trial of Adjuvant Capecitabine and Gemcitabine Followed by Radiotherapy and Concurrent Capecitabine in Extrahepatic Cholangiocarcinoma and Gallbladder Carcinoma. J Clin Oncol 2015; 33:2617-22. [PMID: 25964250 DOI: 10.1200/jco.2014.60.2219] [Citation(s) in RCA: 247] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The role of postoperative therapy in extrahepatic cholangiocarcinoma (EHCC) or gallbladder carcinoma (GBCA) is unknown. S0809 was designed to estimate 2-year survival (overall and after R0 or R1 resection), pattern of relapse, and toxicity in patients treated with this adjuvant regimen. PATIENTS AND METHODS Eligibility criteria included diagnosis of EHCC or GBCA after radical resection, stage pT2-4 or N+ or positive resection margins, M0, and performance status 0 to 1. Patients received four cycles of gemcitabine (1,000 mg/m(2) intravenously on days 1 and 8) and capecitabine (1,500 mg/m(2) per day on days 1 to 14) every 21 days followed by concurrent capecitabine (1,330 mg/m(2) per day) and radiotherapy (45 Gy to regional lymphatics; 54 to 59.4 Gy to tumor bed). With 80 evaluable patients, results would be promising if 2-year survival 95% CI were > 45% and R0 and R1 survival estimates were ≥ 65% and 45%, respectively. RESULTS A total of 79 eligible patients (R0, n = 54; R1, n = 25; EHCC, 68%; GBCA, 32%) were treated (86% completed). For all patients, 2-year survival was 65% (95% CI, 53% to 74%); it was 67% and 60% in R0 and R1 patients, respectively. Median overall survival was 35 months (R0, 34 months; R1, 35 months). Local, distant, and combined relapse occurred in 14, 24, and nine patients. Grade 3 and 4 adverse effects were observed in 52% and 11% of patients, respectively. The most common grade 3 to 4 adverse effects were neutropenia (44%), hand-foot syndrome (11%), diarrhea (8%), lymphopenia (8%), and leukopenia (6%). There was one death resulting from GI hemorrhage. CONCLUSION This combination was well tolerated, has promising efficacy, and provides clinicians with a well-supported regimen. Our trial establishes the feasibility of conducting national adjuvant trials in EHCC and GBCA and provides baseline data for planning future phase III trials.
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Affiliation(s)
- Edgar Ben-Josef
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY.
| | - Katherine A Guthrie
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Anthony B El-Khoueiry
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Christopher L Corless
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Mark M Zalupski
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Andrew M Lowy
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Charles R Thomas
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Steven R Alberts
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Laura A Dawson
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Kenneth C Micetich
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Melanie B Thomas
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Abby B Siegel
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Charles D Blanke
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
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Abstract
Gallbladder carcinoma is the most common malignancy of the biliary tract and is associated with a very poor outcome. The aim of the present study was to investigate the effects of oxymatrine (OM) on gallbladder cancer cells and the possible mechanism of its effects. The effects of OM on the proliferation of gallbladder cancer cells (GBC-SD and SGC-996) were investigated using cell counting kit-8 and colony formation assays. Annexin V/propidium iodide double staining was performed to investigate whether OM could induce apoptosis in gallbladder cancer cells. The mitochondrial membrane potential (ΔΨm) and expression of apoptosis-associated proteins were evaluated to identify a mechanism for the effects of OM. In addition, the RNA expression of relevant genes was measured by qRT-PCR using the SYBR Green method. Finally, a subcutaneous implantation model was used to verify the effects of OM on tumor growth in vivo. We found that OM inhibited the proliferation of gallbladder cancer cells. In addition, Annexin V/propidium iodide double staining showed that OM induced apoptosis after 48 h and the ΔΨm decreased in a dose-dependent manner after OM treatment. Moreover, the activation of caspase-3 and Bax and downregulation of Bcl-2 and nuclear factor κB were observed in OM-treated cells. Finally, OM potently inhibited in-vivo tumor growth following subcutaneous inoculation of SGC-996 cells in nude mice. In conclusion, OM treatment reduced proliferation and induced apoptosis in gallbladder cancer cells, which suggests that this drug may serve as a novel candidate for adjuvant treatment in patients with gallbladder cancer.
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Sirohi B, Singh A, Jagannath P, Shrikhande SV. Chemotherapy and targeted therapy for gall bladder cancer. Indian J Surg Oncol 2014; 5:134-41. [PMID: 25114467 DOI: 10.1007/s13193-014-0317-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 05/13/2014] [Indexed: 12/13/2022] Open
Abstract
Gall bladder cancer is a common cancer in the Ganges belt of North-eastern India. In view of incidental diagnosis of gall bladder cancer by physicians and surgeons, the treatment is not optimised. Most patients present in advanced stages and surgery remains the only option to cure. This review highlights the current evidence in advances in systemic therapy of gall bladder cancer.
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Affiliation(s)
- Bhawna Sirohi
- Department of Medical Oncology, TMC Tata Memorial Centre, Parel Mumbai, 400012 India
| | - Ashish Singh
- Department of Medical Oncology, TMC Tata Memorial Centre, Parel Mumbai, 400012 India
| | - P Jagannath
- Department of Surgical Oncology, Lilavati Hospital and Research centre, Tata Memorial Centre (TMC), Mumbai, India
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Williams TM, Majithia L, Wang SJ, Thomas CR. Defining the Role of Adjuvant Therapy: Cholangiocarcinoma and Gall Bladder Cancer. Semin Radiat Oncol 2014; 24:94-104. [DOI: 10.1016/j.semradonc.2014.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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27
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Hyder O, Dodson RM, Sachs T, Weiss M, Mayo SC, Choti MA, Wolfgang CL, Herman JM, Pawlik TM. Impact of adjuvant external beam radiotherapy on survival in surgically resected gallbladder adenocarcinoma: a propensity score-matched Surveillance, Epidemiology, and End Results analysis. Surgery 2014; 155:85-93. [PMID: 23876364 PMCID: PMC3979596 DOI: 10.1016/j.surg.2013.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 06/05/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND We sought to define the utilization and effect of adjuvant external-beam radiotherapy (XRT) on patients having undergone curative-intent resection for gallbladder cancer (GBC). METHODS Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 5,011 patients with GBC who underwent resection between 1988 and 2009. The impact of XRT on survival was analyzed by the use of propensity-score matching by comparing clinicopathologic factors between patients who received resection only versus resection plus XRT. RESULTS Median age was 72 years, and most patients were female (73.4%); 66.2% patients had intermediate to poorly differentiated tumors, and 19.1% had lymph node metastasis. The majority (75.0%) had "localized" disease by Surveillance, Epidemiology, and End Results classification. A total of 899 patients (17.9%) received XRT whereas 4,112 patients did not. Factors associated with receipt of XRT were younger age (odds ratio [OR] 5.33), tumor extension beyond the serosa (OR 1.55), intermediate- to poorly differentiated tumors (OR 1.56), and lymph node metastasis (OR 2.59) (all P < .05). Median and 1-year survival were 15 months and 59.0%, respectively. On propensity-matched multivariate model, despite having more advanced tumors, XRT was independently associated with better long-term survival at 1 year (hazard ratio 0.45; P < .001), but not 5 years (hazard ratio 1.06; P = .50). CONCLUSION A total of 18% of patients with GBC received XRT after curative intent surgery. The use of adjuvant XRT was associated with a short-term survival benefit, but the benefit dissipated over time.
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Affiliation(s)
- Omar Hyder
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca M Dodson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Teviah Sachs
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Matthew Weiss
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Skye C Mayo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael A Choti
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Joseph M Herman
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Timothy M Pawlik
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
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Image-guided radiation therapy for carcinoma of gallbladder: implication on margin for set-up errors. JOURNAL OF RADIOTHERAPY IN PRACTICE 2013. [DOI: 10.1017/s1460396912000313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractPurposeA retrospective study was undertaken to analyse set-up variations in patients being treated with post-operative radiation therapy for carcinoma of gall bladder by image-guided radiotherapy (IGRT) using cone-beam computed tomography (CBCT) scans and paired kilovoltage beam portals (kVps).Materials and methodsThree consecutive patients receiving post-operative radiation therapy for carcinoma of gall bladder were studied. A total of 32 imaging studies were performed. The immobilisation system was an all-in-one system along with a thermoplastic mask, with knees either resting on the knee rest or in a vacuum cushion. The CBCT scans and kVps were reviewed in an off-line mode. The surrogate markers used for matching during co-registration were 12th rib, coeliac trunk, vertebral bodies and canal. Individual readings were used to calculate mean shifts (m); the mean of these means (M) was calculated to arrive at the systematic error in each direction and its standard deviation (Σ) was calculated. The margins for set-up error (SM) were then calculated.ResultsThere were a total of 32 readings of which 21 were CBCTs and 11 were kVps. The mean shifts in each direction for each patient were 0·06, 0·25 and 0·15 cm in vertical, longitudinal and lateral directions, respectively. The resultant planning target volume margins calculated were 0·24, 0·9 and 0·47 cm in vertical, longitudinal and lateral directions.ConclusionsIGRT for upper abdominal malignancies using CBCT and kVps is a useful method to keep the margins for set-up error low. The use of surrogates for matching should be relevant to the target volume. Good immobilisation system helps in keeping the margins low.
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Wang RT, Xu XS, Liu J, Liu C. Gallbladder carcinoma: analysis of prognostic factors in 132 cases. Asian Pac J Cancer Prev 2013; 13:2511-4. [PMID: 22938413 DOI: 10.7314/apjcp.2012.13.6.2511] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To evaluate the prognostic factors of gallbladder carcinoma. METHODS Presentation, operative data, complications, and survival outcome were examined for 132 gallbladder carcinoma patients who underwent gallbladder surgery in our unit during 2002-2007, and follow-up results were obtained from every patient for univariate and multivariate survival analysis. RESULTS The univariate analysis showed that gallbladder lesion history, tumor cell differentiation, Nevin staging, preoperative lymph node metastasis and the surgical approach significantly correlated with the prognosis of the patients (p <0.05). The results of the multivariate analysis (Cox regression) showed that gallbladder lesion history, Nevin staging and the surgical approach were independent predicators with relative risks of 6.9, 4.4, 2.8, respectively (p=0.002, 0.003, 0.008). CONCLUSION Gallbladder lesion history, Nevin staging and the surgical approach are independent prognostic factors for gallbladder carcinoma, a rapidly fatal disease. Therefore, early diagnosis, anti-infective therapy and radical surgery are greatly needed to improve the prognosis of gallbladder carcinoma.
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Affiliation(s)
- Rui-Tao Wang
- Department of hepatobiliary surgery, the First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
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Boutros C, Gary M, Baldwin K, Somasundar P. Gallbladder cancer: past, present and an uncertain future. Surg Oncol 2012; 21:e183-91. [PMID: 23025910 DOI: 10.1016/j.suronc.2012.08.002] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 08/27/2012] [Accepted: 08/28/2012] [Indexed: 02/06/2023]
Abstract
Although gallbladder cancer (GBC) is the most common malignancy of the biliary tract, its relatively low incidence and confounding symptomatology result in advanced disease at the time presentation, contributing to the poor prognosis and decreased survival associated with this disease. It is therefore increasingly important to understand its pathogenesis and risk factors to allow for the earliest possible diagnosis. To date, gallbladder cancer is poorly understood compared to other malignancies, and is still most commonly discovered incidentally after cholecystectomy. Moreover, while much is known about biliary neoplasms as a whole, understanding the clinical and molecular nuances of GBC as a separate disease process will prove a cornerstone in the development of early intervention, potential screening and overall more effective treatment strategies. The present work reviews the most current understanding of the pathogenesis, diagnosis, staging and natural history of GBC, with additional focus on surgical treatment. Further, review of current adjuvant therapies for unresectable and advanced disease as well as prognostic factors provide fertile ground for the development of future studies which will hopefully improve treatment outcomes and affect overall survival for this highly morbid, poorly understood malignancy.
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Affiliation(s)
- C Boutros
- University of Maryland School of Medicine, Division of Surgical Oncology, Baltimore, MD, USA
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Kim K, Chie EK, Jang JY, Kim SW, Han SW, Oh DY, Im SA, Kim TY, Bang YJ, Ha SW. Postoperative chemoradiotherapy for gallbladder cancer. Strahlenther Onkol 2012; 188:388-92. [PMID: 22402869 DOI: 10.1007/s00066-012-0074-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Accepted: 01/11/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The goal of this work was to analyze the outcome of adjuvant chemoradiotherapy for patients with gallbladder cancer who underwent surgical resection and to identify the prognostic factors for these patients. PATIENTS AND METHODS Between August 1989 and November 2006, 47 patients with gallbladder cancer underwent surgical resection followed by adjuvant radiotherapy. There were 21 males and 26 females, and median age was 60 years (range 44-75 years). Postoperative radiotherapy was delivered to the tumor bed and regional lymph nodes up to 40-50 Gy at 2 Gy/fraction; 41 patients also received intravenous 5-fluorouracil as a radiosensitizer. Median follow-up duration was 48 months for survivors. RESULTS There were 2 isolated locoregional recurrences, 14 isolated distant metastases, and 7 combined locoregional and distant relapses. The 5-year overall survival rate was 43.7%. According to the extent of resection, the 5-year overall survival rates were 52.8%, 20.0%, and 0% in R0-, R1-, and R2-resected patients, respectively (p = 0.0038). On multivariate analysis incorporating extent of resection, T stage, N stage, performance of lymph node dissection, and histologic differentiation, extent of resection was the only prognostic factor associated with overall survival (p = 0.0075). Among the 37 patients with R0 resection, there was no difference of 5-year overall survival rates in patients with N0, N1, and Nx diseases (46.2%, 60.0%, and 44.4%, respectively, p = 0.6246). As for significant treatment-related morbidity, there was only 1 patient with grade 4 gastric ulcer. CONCLUSION Adjuvant chemoradiotherapy after R0 resection can achieve a good long-term survival rate in gallbladder cancer patients, even in those with lymph node metastases, and may play a role for patients who underwent R0 resection of primary tumor without lymph node dissection.
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Affiliation(s)
- K Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, Korea
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Wang SJ, Lemieux A, Kalpathy-Cramer J, Ord CB, Walker GV, Fuller CD, Kim JS, Thomas CR. Nomogram for predicting the benefit of adjuvant chemoradiotherapy for resected gallbladder cancer. J Clin Oncol 2011; 29:4627-32. [PMID: 22067404 PMCID: PMC3236647 DOI: 10.1200/jco.2010.33.8020] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 07/18/2011] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Although adjuvant chemoradiotherapy for resected gallbladder cancer may improve survival for some patients, identifying which patients will benefit remains challenging because of the rarity of this disease. The specific aim of this study was to create a decision aid to help make individualized estimates of the potential survival benefit of adjuvant chemoradiotherapy for patients with resected gallbladder cancer. METHODS Patients with resected gallbladder cancer were selected from the Surveillance, Epidemiology, and End Results (SEER) -Medicare database who were diagnosed between 1995 and 2005. Covariates included age, race, sex, stage, and receipt of adjuvant chemotherapy or chemoradiotherapy (CRT). Propensity score weighting was used to balance covariates between treated and untreated groups. Several types of multivariate survival regression models were constructed and compared, including Cox proportional hazards, Weibull, exponential, log-logistic, and lognormal models. Model performance was compared using the Akaike information criterion. The primary end point was overall survival with or without adjuvant chemotherapy or CRT. RESULTS A total of 1,137 patients met the inclusion criteria for the study. The lognormal survival model showed the best performance. A Web browser-based nomogram was built from this model to make individualized estimates of survival. The model predicts that certain subsets of patients with at least T2 or N1 disease will gain a survival benefit from adjuvant CRT, and the magnitude of benefit for an individual patient can vary. CONCLUSION A nomogram built from a parametric survival model from the SEER-Medicare database can be used as a decision aid to predict which gallbladder patients may benefit from adjuvant CRT.
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Affiliation(s)
- Samuel J Wang
- Oregon Health & Science University, Portland, 97239-3098, USA.
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González ME, Giannini OH, González P, Saldaña B. Adjuvant radio-chemotherapy after extended or simple cholecystectomy in gallbladder cancer. Clin Transl Oncol 2011; 13:480-4. [PMID: 21775275 DOI: 10.1007/s12094-011-0685-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To analyse results of combined treatment of adjuvant radio-chemotherapy (RT-CT) in patients diagnosed with gallbladder cancer (GBC) after complete resection. METHODS AND MATERIAL From June 1993 until July 2006, 67 patients with a diagnosis of GBC who underwent R0 surgical resection and were staged as T1b-2-3N0-1M0 received adjuvant RT-CT. Radiotherapy consisted of whole abdominal irradiation (20 Gy at 100 cGy daily) plus a boost to the tumour bed for a total of 45-59.4 Gy. Concomitant chemotherapy (fluoropyrimidines) was given. Overall survival (OS) and median survival were analysed in relation to different prognostic factors. RESULTS With a median follow-up of 90 months, 5-year OS was 41%, in the group who underwent extended cholecystectomy it reached 57% and it was only 27% in those who underwent simple cholecystectomy (p = 0.005). Median survival was 42 months for the whole population, not yet reached for the extended cholecystectomy subgroup and 23 months for the simple cholecystectomy subgroup. When analysing for histological grade, median survival was 23 months for those graded as high grade (III or IV) and 57 months for those of low-unknown grade (p = 0.029). In multivariate analysis, a statistically significant OS benefit was found for those who underwent extended cholecystectomy (p = 0.003). CONCLUSIONS In the absence of randomised studies, these data support the use of extended cholecystectomy followed by adjuvant RT-CT in patients diagnosed as stages T1b-2- 3N0-1M0 GBC after R0 resection.
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Affiliation(s)
- Manuel E González
- Department of Radiotherapy, Instituto Oncológico, Viña del Mar, Chile.
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Sun XN, Cao WG, Wang X, Wang Q, Gu BX, Yang QC, Hu JB, Liu H, Zheng S. Prognostic impact of vascular endothelial growth factor-A expression in resected gallbladder carcinoma. Tumour Biol 2011; 32:1183-90. [PMID: 21853312 DOI: 10.1007/s13277-011-0221-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 08/05/2011] [Indexed: 12/11/2022] Open
Abstract
The purpose of this study was to evaluate the value of vascular endothelial growth factor-A (VEGF-A) expression and other confirmed prognostic factors in predicting clinical outcomes after the resection of gallbladder carcinoma (GBC). Between January 1999 and January 2006, a total of 84 consecutive and non-selected patients who underwent resection for GBC were retrospectively reviewed. Of the 84 patients studied, 45 cases (53.6%) exhibited high expression of VEGF-A and were placed into the high expression group. The 14 cases (16.7%) that showed no VEGF expression and the 25 cases (29.7%) that had lower VEGF-A levels were pooled into the low expression group (46.4%). There was a relationship between VEGF-A status and pM stage (P = 0.027) as well as histologic differentiation (P < 0.001). In univariate analysis by log-rank test, ECOG performance status, CA 19-9, pN stage, pM stage, histologic differentiation, and VEGF-A expression were significant prognostic factors (P = 0.015, 0.001, 0.020, <0.001, 0.040, and <0.001, respectively). Multivariate analysis revealed that pN status and VEGF-A expression maintained independent prognostic influence on overall survival (P < 0.001 and P = 0.013, respectively). VEGF-A expression has a positive correlation with pM stage and histologic differentiation. pN status and VEGF-A expression were independent prognostic factors of overall survival in patients with resected GBC.
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Affiliation(s)
- Xiao-Nan Sun
- Department of Radiation Oncology of Sir Run Run Shaw Hospital, Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, China
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Kim S, Kim K, Chie EK, Kim SW, Bang YJ, Ha SW. Treatment outcomes and prognostic factors of gallbladder cancer patients after postoperative radiation therapy. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2011; 15:152-6. [PMID: 26421032 PMCID: PMC4582537 DOI: 10.14701/kjhbps.2011.15.3.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 07/12/2011] [Accepted: 08/14/2011] [Indexed: 11/17/2022]
Abstract
Backgrounds/Aims To investigate survival rates and prognostic factors of patients with gallbladder cancer who were treated with surgery and postoperative radiation therapy. Methods Seventeen gallbladder cancer patients who received surgery and postoperative radiotherapy from October 1989 to April 1998 were included in this retrospective study. Five patients had stage II, 8 patients had stage III, and 4 patients had stage IV disease according to the 1997 American Joint Committee on Cancer (AJCC) staging. All patients received ≥40 Gy of postoperative radiotherapy with a daily dose of 2.0 Gy/fraction and 15 patients received concurrent chemotherapy. An analysis was performed for the end-points of overall and disease-free survival. Results Of the 17 patients, 13 had no residual disease (R0), 1 had microscopic residual disease (R1), and 3 had macroscopic residual disease (R2) after surgery. Among patients with no residual disease, 4 had locoregional recurrences during the follow-up period. One patient with microscopic residual disease had local recurrence. The 5-year overall survival rate was 38.2%. The median overall survival time was 21 months and the median disease-free survival time was 12 months. Old age (≥60 years old), female gender, a high pathological stage (≥IVA), and the presence of residual disease after surgery were significant prognostic factors for disease-free survival. Conclusions Despite a high proportion of patients with advanced disease and macroscopic residual disease, the prognosis of gallbladder patients who had postoperative radiotherapy is encouraging. Additional investigation to improve the loco-regional control of gallbladder cancer patients with adverse prognostic factors is warranted.
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Affiliation(s)
- Suzy Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| | - Sun Whe Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yung-Jue Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Whan Ha
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
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Bonet Beltrán M, Roth AD, Mentha G, Allal AS. Adjuvant radio-chemotherapy for extrahepatic biliary tract cancers. BMC Cancer 2011; 11:267. [PMID: 21702920 PMCID: PMC3141778 DOI: 10.1186/1471-2407-11-267] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Accepted: 06/24/2011] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Extrahepatic biliary duct cancers (EBDC) are uncommon malignancies characterized by a poor prognosis with high rate of loco-regional recurrence. The purpose of the present study is to assess the feasibility and the potential impact of adjuvant radiotherapy (RT) in a series of patients treated in one institution. METHODS Twenty three patients with non-metastatic bile duct cancer treated surgically with curative intent (4 gallbladder, 7 ampullary and 12 cholangiocarcinoma) received 3D conformal external beam RT to a median total dose of 50.4 Gy. Concurrent chemotherapy based on 5-FU was delivered to 21 patients (91%). Surgical margins were negative in 11 patients (48%), narrow in 2 (9%), and microscopically involved in 8 (35%). Eleven patients (55%) had metastatic nodal involvement. The average follow-up time for all patients was 30 months (ranging from 3-98). RESULTS Acute gastrointestinal grade 2 toxicity (RTOG scale) was recorded in 2 patients (9%). Nausea or vomiting grade 1 and 2 was observed in 8 (35%) and 2 patients (9%) respectively. Only one patient developed a major late radiation-induced toxicity. The main pattern of recurrence was both loco-regional and distant (liver, peritoneum and/or lung). No difference was observed in loco-regional control according to the tumor location. The 5-year actuarial loco-regional control rate was 48.3% (67% and 30% for patients operated on with negative and positive/narrow/unknown margins respectively, p=0.04). The 5-year actuarial overall survival was of 35.9% for the entire group (61.4% in case of negative margins and 16.7% in case of positive/narrow/unknown margins, p=0.07). CONCLUSIONS Postoperative RT with 50-60 Gy is feasible with acceptable acute and late toxicities. The potential benefit observed in our series may support the use of adjuvant RT in patients with locally advanced disease. Prospective randomized trials are warranted to confirm definitively the role of RT in this tumor location.
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Affiliation(s)
- Marta Bonet Beltrán
- Servei d'Oncologia Radioteràpica, Consorci Sanitari de Terrassa, Institut Oncològic del Vallès (CST-HGC-CSPT), Ctra. Torrebonica s/n. 08227 Terrassa - Barcelona, Spain
- Radiation-Oncology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland
| | - Arnaud D Roth
- Onco-Surgery and Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4 1211 Genève 14, Switzerland
| | - Gilles Mentha
- Onco-Surgery and Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4 1211 Genève 14, Switzerland
| | - Abdelkarim S Allal
- Radiation-Oncology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland
- Radiation-Oncology, HFR-Fribourg, Chemin des Pensionnats 2-6, 1752 Villars-sur-Glâne, Switzerland
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Bonet Beltrán M, Allal AS, Gich I, Solé JM, Carrió I. Is adjuvant radiotherapy needed after curative resection of extrahepatic biliary tract cancers? A systematic review with a meta-analysis of observational studies. Cancer Treat Rev 2011; 38:111-9. [PMID: 21652148 DOI: 10.1016/j.ctrv.2011.05.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 05/03/2011] [Accepted: 05/04/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND The role for adjuvant radiotherapy (ART) after curative resection in extrahepatic cholangiocarcinoma remains unclear. Due to the lack of randomized trials, available data comes from single center experiences or data-based population studies with inconclusive results. OBJECTIVE To assess the impact of radiotherapy (with or without concurrent chemotherapy) on toxicity and survival of radically resected patients with extrahepatic bile duct cancer (extrahepatic cholangiocarcinoma, gallbladder cancer and pure ampullary cancer). DATA SOURCES AND STUDY SELECTION Eligible studies with data on survival, recurrence and toxicity were retrieved from the MEDLINE, ISI web of science, EMBASE and Cochrane databases from January 1995 to December 2008, to ensure that all ART treatments were performed with conventional 3D techniques. In the absence of randomized controlled-studies, all observational cohort studies (longitudinal and historical) were initially considered. Ten retrospective cohort studies (where the use of concurrent CT was reported only in 2), met all inclusion criteria and were enrolled for final meta-analysis. Hazard ratio (HR) had to be extracted from survival curves using the Tierney et al. methods. MIX 1.7 statistical software was used for meta-analysis. RESULTS All studies on ART used conventional 3D-techniques. Patients in the ART cohorts were more likely to have involved surgical margins and positive lymph nodes. For extrahepatic cholangiocarcinoma location, ART significantly improved overall survival (HR 0.62; 95% CI 0.48 to 0.78, p<0.001). Meta-analysis was not feasible for gallbladder cancer and ampullary cancer locations. Late radiation-induced toxicity was low (2-9% late obstruction or GI bleeding). CONCLUSION In the absence of randomized controlled studies, we found in the present systematic review and meta-analysis of observational studies that, patients with extrahepatic cholangiocarcinoma treated with adjuvant RT have a significant lower risk of dying compared to patients treated with surgery alone.
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Affiliation(s)
- Marta Bonet Beltrán
- Radiation Oncology, Consorci Sanitari de Terrassa, Institut Oncològic del Vallès (CST-HGC-CSPT), Barcelona, Spain.
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Murakami Y, Uemura K, Sudo T, Hashimoto Y, Nakashima A, Kondo N, Sakabe R, Kobayashi H, Sueda T. Prognostic factors of patients with advanced gallbladder carcinoma following aggressive surgical resection. J Gastrointest Surg 2011; 15:1007-16. [PMID: 21547707 DOI: 10.1007/s11605-011-1479-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 02/27/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prognosis for patients with advanced gallbladder carcinoma is dismal despite aggressive surgical resection. The aim of this study is to determine useful prognostic factors for patients with gallbladder carcinoma following aggressive surgical resection. METHODS Medical records of 62 patients with gallbladder carcinoma who underwent surgical resection were retrospectively reviewed. Univariate and multivariate models were used to analyze the effect of clinicopathological factors on long-term survival. RESULTS According to the UICC staging system, ten (16%), 11 (18%), eight (13%), 16 (25%), nine (15%), and eight patients (13%) were diagnosed with stages I, II, IIIA, IIIB, IVA, and IVB disease, respectively. Partial hepatectomy and pancreatoduodenectomy were performed for 43 (69%) and 11 (18%) patients, respectively. Overall survival rates of all 62 and 41 patients with UICC stages III and IV disease were 71% and 56% at 1 year, 48% and 23% at 3 years, and 48% and 23% at 5 years, respectively (median survival time, 15.8 and 12.7 months, respectively). Multivariate analysis revealed that independent prognostic factors included tumor differentiation (p = 0.006), hepatic invasion (p = 0.002), lymph node metastasis (p = 0.009), and surgical margin status (p = 0.002) for all patients, and adjuvant chemotherapy (p = 0.005), tumor differentiation (p = 0.008), hepatic invasion (p = 0.001), and surgical margin status (p = 0.022) for patients with UICC stages III and IV disease. CONCLUSIONS R0 resection and adjuvant chemotherapy are significant prognostic factors in advanced gallbladder carcinoma and should be performed to improve survival.
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Affiliation(s)
- Yoshiaki Murakami
- Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
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Sun XN, Wang Q, Gu BX, Zhu YH, Hu JB, Shi GZ, Zheng S. Adjuvant radiotherapy for gallbladder cancer: A dosimetric comparison of conformal radiotherapy and intensity-modulated radiotherapy. World J Gastroenterol 2011; 17:397-402. [PMID: 21253402 PMCID: PMC3022303 DOI: 10.3748/wjg.v17.i3.397] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 09/29/2010] [Accepted: 10/07/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the efficacy and toxicity of conformal radiotherapy (CRT) and compare with intensity-modulated radiotherapy (IMRT) in the treatment of gallbladder cancer.
METHODS: Between November 2003 and January 2010, 20 patients with gallbladder cancer were treated with CRT with or without chemotherapy after surgical resection. Preliminary survival data were collected and examined using both Kaplan-Meier and actuarial analysis. Demographic and treatment parameters were collected. All patients were planned to receive 46-56 Gy in 1.8 or 2.0 Gy per fraction. CRT planning was compared with IMRT.
RESULTS: The most common reported acute toxicities requiring medication (Radiation Therapy Oncology Group, Radiation Therapy Oncology Group Grade 2) were nausea (10/20 patients) and diarrhea (3/20). There were no treatment-related deaths. Compared with CRT planning, IMRT significantly reduced the volume of right kidney receiving > 20 Gy and the volume of liver receiving > 30 Gy. IMRT has a negligible impact on the volume of left kidney receiving > 20 Gy. The 95% of prescribed dose for a planning tumor volume using either 3D CRT or IMRT planning were 84.0% ± 6.7%, 82.9% ± 6.1%, respectively (P > 0.05).
CONCLUSION: IMRT achieves similar excellent target coverage as compared with CRT planning, while reducing the mean liver dose and volume above threshold dose. IMRT offers better sparing of the right kidney compared with CRT planning, with a significantly lower mean dose and volume above threshold dose.
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Abahssain H, Afchain P, Melas N, Ismaili N, Rahali R, Rabti HM, Errihani H. [Chemotherapy in gallbladder carcinoma]. Presse Med 2010; 39:1238-45. [PMID: 21074352 DOI: 10.1016/j.lpm.2010.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 08/26/2010] [Accepted: 09/01/2010] [Indexed: 02/03/2023] Open
Abstract
Gallbladder cancer is an aggressive tumor. Its incidence varies according to geography. Surgery is the standard treatment for localized stage but there is no standard treatment in metastatic or locally advanced disease. Because of the rarity of bile tract cancer (BTC) and gallblader carcinoma (GBC), most studies have grouped all BTC and GBC together, and there are very few GBC-specific studies. In addition, there is a paucity of randomized controlled studies in this disease with small numbers of patients and inclusion bias. One randomized trial ABC-02 was well conducted and showed a survival benefit in favor of gemcitabine (GEM)+cisplatin (CDDP), which can be regarded as the standard in locally advanced BTC. Adjuvant therapy after surgical resection is not validated. Understanding the molecular mechanisms of carcinogenesis of GBC has opened the way for the use of targeted therapies. This new treatment would improve survival and quality of life of our patients.
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Affiliation(s)
- Halima Abahssain
- Institut national d'oncologie, service d'oncologie médicale, 10100 Rabat, Maroc.
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Boucher E, Pracht M, Roux C, Boudjema K, Raoul JL. Adjuvant treatment after resection of biliary-tract cancer: yes or no? Oncol Rev 2010. [DOI: 10.1007/s12156-010-0047-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Williams KJ, Picus J, Trinkhaus K, Fournier CC, Suresh R, James JS, Tan BR. Gemcitabine with carboplatin for advanced biliary tract cancers: a phase II single institution study. HPB (Oxford) 2010; 12:418-26. [PMID: 20662793 PMCID: PMC3028583 DOI: 10.1111/j.1477-2574.2010.00197.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Only recently has a standard chemotherapy regimen, gemcitabine plus cisplatin, been established for advanced biliary tract cancers (BTCs) based on a phase III randomized study. The aim of this phase II single-institution trial was to assess the efficacy and safety of gemcitabine combined with carboplatin in the first-line treatment of patients with advanced BTCs. METHODS Patients with histologically proven BTCs, including cholangiocarcinoma or gallbladder and ampullary carcinomas, were treated with a maximum of nine cycles of intravenous (i.v.) gemcitabine at 1000 mg/m(2) over 30 min on days 1 and 8 with i.v. carboplatin dosed at an area-under-the-curve (AUC) of 5 over 60 min on day 1 of a 21-day cycle. RESULTS A total of 48 patients with advanced BTCs (35 cholangiocarcinoma, 12 gallbladder and 1 ampullary cancer) were enrolled. A median of four cycles were administered (range: 1-9). The overall response rate for evaluable patients was 31.1%. Median progression-free survival, overall survival and 6-month survival rates are 7.8 months, 10.6 months and 85.4%, respectively. The most common grade 3-4 toxicities include neutropenia and thrombocytopenia. Grade 3 or 4 non-haematological toxicities were rare. CONCLUSIONS Gemcitabine combined with carboplatin has activity against advanced BTCs. Our results are comparable to other gemcitabine-platinum or gemcitabine-fluoropyrimidine combinations in advanced BTCs.
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Affiliation(s)
- Kerry J Williams
- Division of Medical Oncology, Washington University School of MedicineSaint Louis, MI, USA
| | - Joel Picus
- Division of Medical Oncology, Washington University School of MedicineSaint Louis, MI, USA
| | - Kim Trinkhaus
- Department of Biostatistics, Washington University School of MedicineSaint Louis, MI, USA
| | - Chloe C Fournier
- Division of Medical Oncology, Washington University School of MedicineSaint Louis, MI, USA
| | - Rama Suresh
- Division of Medical Oncology, Washington University School of MedicineSaint Louis, MI, USA
| | - Joan S James
- Division of Medical Oncology, Washington University School of MedicineSaint Louis, MI, USA
| | - Benjamin R Tan
- Division of Medical Oncology, Washington University School of MedicineSaint Louis, MI, USA
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Cho SY, Kim SH, Park SJ, Han SS, Kim YK, Lee KW, Lee WJ, Woo SM, Kim TH. Adjuvant chemoradiation therapy in gallbladder cancer. J Surg Oncol 2010; 102:87-93. [PMID: 20578085 DOI: 10.1002/jso.21544] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Gallbladder cancer is a relatively uncommon gastrointestinal malignancy. Indications for adjuvant chemoradiation therapy after surgical resection have not yet been determined. We aimed this study to elucidate the effectiveness of adjuvant chemoradiation therapy according to TNM stage for gallbladder cancer. METHODS Between March 2001 and March 2009, 100 patients with gallbladder cancer underwent surgical resection. We divided the patients according to TNM stage, and subdivided further according to whether adjuvant chemoradiation therapy was added or not. The clinicopathologic factors, recurrence and survival were retrospectively analyzed. RESULTS Patients with gallbladder cancer at T2N0M0, T2N1M0, T3N0M0, and T3N1M0 stages were enrolled in this study. Among the four stages, the two lymph node-negative stages (T2N0M0 and T3N0M0) did not show any gain in survival by adding adjuvant chemoradiation therapy. Conversely, the remaining lymph node-positive stages (T2N1M0 and T3N1M0) showed gain in disease-free survival, and the lymph node-positive T2 stage (T2N1M0) showed gain in disease-specific survival. In patients with lymph node-positive T2/T3 GB cancers, adjuvant chemoradiation therapy was an independent prognostic factor for survival. CONCLUSIONS Adjuvant chemoradiation therapy is recommended for lymph node-positive T2/T3 gallbladder cancer following surgical resection.
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Affiliation(s)
- Seong Yeon Cho
- Center for Liver Cancer, National Cancer Center, Gyeonggi-do, Republic of Korea
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Abstract
Resection is a means of improving survival in patients with gallbladder cancer. A more aggressive surgical approach, including resection of the gallbladder, liver, and regional lymph nodes, is advisable for patients with T1b to T4 tumors. Aggressive resection is necessary because a patient's gallbladder cancer stage determines the outcome, not the surgery itself. Therefore, major resections should be offered to appropriately selected patients. Patients with advanced tumors or metastatic disease are not candidates for radical resection and thus should be directed to more suitable palliation.
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Affiliation(s)
- Shiva Jayaraman
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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Abstract
Gallbladder cancer (GBC) represents the most common and aggressive type among the biliary tree cancers (BTCs). Complete surgical resection offers the only chance for cure; however, only 10% of patients with GBC present with early-stage disease and are considered surgical candidates. Among those patients who do undergo "curative" resection, recurrence rates are high. There are no established adjuvant treatments in this setting. Patients with unresectable or metastatic GBC have a poor prognosis. There has been a paucity of randomized phase III data in this field. A recent report demonstrated longer overall survival with gemcitabine in combination with cisplatin than with gemcitabine alone in patients with advanced or metastatic BTCs. Molecularly targeted agents are under development. In this review, we attempt to discuss the current status and key issues involved in the management of GBC.
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Affiliation(s)
- Andrew X Zhu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Adjuvant gemcitabine plus S-1 chemotherapy improves survival after aggressive surgical resection for advanced biliary carcinoma. Ann Surg 2010; 250:950-6. [PMID: 19953713 DOI: 10.1097/sla.0b013e3181b0fc8b] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of adjuvant gemcitabine plus S-1 chemotherapy after aggressive surgical resection for advanced biliary carcinoma. SUMMARY BACKGROUND DATA No effective adjuvant therapy for advanced biliary carcinoma has been reported although its prognosis is extremely poor. METHODS Medical records were reviewed for 103 patients with International Union Against Cancer (UICC) stage II biliary carcinoma who underwent aggressive surgical resection. About 50 patients received 10 cycles of adjuvant gemcitabine plus S-1 chemotherapy and 53 patients did not. Clinicopathological factors and patient survival were compared between the 2 groups using univariate and multivariate analysis. A cycle of chemotherapy consisted of intravenous gemcitabine 700 mg/m(2) on day 1 and oral S-1 50 mg/m(2) for 7 consecutive days, followed by a 1-week break from chemotherapy. RESULTS Patient demographics, tumor characteristics, and surgical procedures did not differ between the 2 groups. Aggressive surgical procedures including major hepatectomy or pancreatoduodenectomy were performed for 94 of 103 patients. In the chemotherapy group, 37 patients (74%) were given the full number of 10 cycles. The use of postoperative adjuvant chemotherapy (P < 0.001) and surgical margin status (P = 0.003) were independently associated with long-term survival by multivariate analysis. Five-year survival rates of patients who did or did not receive postoperative adjuvant chemotherapy were 57% and 24%, respectively (P < 0.001). Toxicity during chemotherapy was mild. CONCLUSIONS Adjuvant gemcitabine plus S-1 chemotherapy may be one of several factors contributing to improved outcomes after aggressive surgical resection of advanced biliary carcinoma in recent years.
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Fuller CD, Dang ND, Wang SJ, Desai P, Choi M, Thomas CR, Fuss M. Image-guided intensity-modulated radiotherapy (IG-IMRT) for biliary adenocarcinomas: Initial clinical results. Radiother Oncol 2009; 92:249-54. [PMID: 19324442 DOI: 10.1016/j.radonc.2009.02.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 02/18/2009] [Accepted: 02/26/2009] [Indexed: 12/12/2022]
Abstract
PURPOSE Biliary tract lesions are comparatively rare neoplasms, with ambiguous indications for radiotherapy. The specific aim of this study was to report the clinical results of a single-institution biliary tract series treated with modern radiotherapeutic techniques, and detail results using both conventional and image-guided intensity-modulated radiation therapy (IG-IMRT). METHODS AND MATERIALS From 2001 to 2005, 24 patients with primary adenocarcinoma of the biliary tract (gallbladder and extrahepatic bile ducts) were treated by IG-IMRT. To compare outcomes, data from a sequential series of 24 patients treated between 1995 and 2005 with conventional radiotherapy (CRT) techniques were collected as a comparator set. Demographic and treatment parameters were collected. Endpoints analyzed included treatment-related acute toxicity and survival. RESULTS Median estimated survival for all patients completing treatment was 13.9 months. A statistically significant higher mean dose was given to patients receiving IG-IMRT compared to CRT, 59 vs. 48Gy. IG-IMRT and CRT cohorts had a median survival of 17.6 and 9.0 months, respectively. Surgical resection was associated with improved survival. Two patients (4%) experienced an RTOG acute toxicity score>2. The most commonly reported GI toxicities (RTOG Grade 2) were nausea or diarrhea requiring oral medication, experienced by 46% of patients. CONCLUSION This series presents the first clinical outcomes of biliary tract cancers treated with IG-IMRT. In comparison to a cohort of patients treated by conventional radiation techniques, IG-IMRT was feasible for biliary tract tumors, warranting further investigation in prospective clinical trials.
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Affiliation(s)
- Clifton David Fuller
- Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
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Hueman MT, Vollmer CM, Pawlik TM. Evolving treatment strategies for gallbladder cancer. Ann Surg Oncol 2009; 16:2101-15. [PMID: 19495882 DOI: 10.1245/s10434-009-0538-x] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 04/27/2009] [Accepted: 04/28/2009] [Indexed: 12/13/2022]
Abstract
Gallbladder cancer is an uncommon cancer that has traditionally been associated with a poor prognosis. In the era of laparoscopic cholecystectomy, incidental gallbladder cancer has dramatically increased and now constitutes the major way patients present with gallbladder cancer. While patients with incidental gallbladder cancer have a better survival than patients with nonincidental gallbladder cancer, incidental gallbladder cancer can be associated with a varied prognosis. Imaging with computed tomography (CT), magnetic resonance imaging (MRI), and [18]F-fluorodeoxyglucose (FDG) positron emission tomography (PET), as well as diagnostic laparoscopy, all have varying roles in the workup of patients with incidental gallbladder cancer. For patients with T1b, T2, and T3 incidental gallbladder cancer re-resection is generally recommended. At re-exploration, many patients with incidental gallbladder cancer will have residual disease. Definitive oncologic management requires re-resection of the liver, portal lymphadenectomy, and attention to the common bile duct. The extent of the hepatic resection should be dictated by the ability to achieve a microscopically negative (R0) margin. Routine resection of the common bile duct is unnecessary but should be undertaken in the setting of a positive cystic duct margin. If an incidental gallbladder cancer is discovered at the time of surgery, whether the surgeon should directly proceed with a more definitive oncologic operation should depend on the surgeon's skill-set and experience. Gallbladder cancer has a propensity to recur. Although data for adjuvant therapy following resection are limited, some data do suggest a survival benefit for adjuvant chemoradiation therapy. Management of patients with gallbladder cancer requires a multidisciplinary approach with input from a surgeon skilled in hepatobiliary surgery.
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Affiliation(s)
- Matthew T Hueman
- Departments of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Choi M, Fuller CD, Wang SJ, Siddiqi A, Wong A, Thomas CR, Fuss M. Effect of body mass index on shifts in ultrasound-based image-guided intensity-modulated radiation therapy for abdominal malignancies. Radiother Oncol 2009; 91:114-9. [PMID: 18804301 PMCID: PMC11357792 DOI: 10.1016/j.radonc.2008.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Revised: 07/30/2008] [Accepted: 08/09/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE We investigated whether corrective shifts determined by daily ultrasound-based image-guidance correlate with body mass index (BMI) of patients treated with image-guided intensity-modulated radiation therapy (IG-IMRT) for abdominal malignancies. The utility of daily image-guidance, particularly for patients with BMI>25.0, is examined. MATERIALS AND METHODS Total 3162 ultrasound-directed shifts were performed in 86 patients. Direction and magnitude of shifts were correlated with pretreatment BMI. Bivariate statistical analysis and analysis of set-up correction data were performed using systematic and random error calculations. RESULTS Total 2040 daily alignments were performed. Average 3D vector of set-up correction for all patients was 12.1mm/fraction. Directional and absolute shifts and 3D vector length were significantly different between BMI cohorts. 3D displacement averaged 4.9 mm/fraction and 6.8mm/fraction for BMI < or = 25.0 and BMI>25.0, respectively. Systematic error in all axes and 3D vector was significantly greater for BMI>25.0. Differences in random error were not statistically significant. CONCLUSIONS Set-up corrections derived from daily ultrasound-based IG-IMRT of abdominal tumors correlated with BMI. Daily image-guidance may improve precision of IMRT delivery with benefits assessed for the entire population, particularly patients with increased habitus. Requisite PTV margins suggested in the absence of daily image-guidance are significantly greater in patients with BMI>25.0.
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Affiliation(s)
- Mehee Choi
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Clifton D. Fuller
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Division of Radiological Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Samuel J. Wang
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Adrian Wong
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Charles R. Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Martin Fuss
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA
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