Vikram A Chaudhari1, Vikas Ostwal2, Shraddha Patkar1, Arvind Sahu2, Anup Toshniwal2, Anant Ramaswamy2, Nitin S Shetty3, Shailesh V Shrikhande1, Mahesh Goel4. 1. GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India. 2. Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India. 3. Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India. 4. GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India. Electronic address: drmaheshgoel@gmail.com.
Abstract
BACKGROUND: Studies evaluating neo-adjuvant chemotherapy (NACT) exclusively in gallbladder cancer (GBC) are few and there are no randomized trials on the subject. Locally advanced GBC and indications for NACT in GBC are not yet clearly defined. METHODS: We analysed 160 consecutive GBC patients who received NACT based on clinico-radiologic criteria suggesting high-risk disease (TMH Criteria) from January 2010 to February 2016. RESULTS: On initial assessment, 140 (87.5%) patients had T3/T4 disease and 105 (65%) patients were node positive. Response rate and clinical benefit rate was 52.5% and 70% respectively. Sixty six (41.2%) patients could undergo curative intent resection. With a median follow-up of 33 months, the median OS and EFS of the entire cohort were 13 and 8 months respectively. Patient undergoing curative surgery had a statistically superior OS (49 vs. 7 months; p = 0.0001) and EFS (25 months vs. 5 months; p = 0.0001) compared to those who did not. CONCLUSION: Locally advanced GBC remains a disease with poor prognosis. Chemotherapy with neoadjuvant intent in locally advanced/borderline resectable GBC showed good response rates. This resulted in curative surgical resection or disease stabilisation in significant proportion of patients. Patients who undergo definitive surgery after favourable response to NACT experience good survival.
BACKGROUND: Studies evaluating neo-adjuvant chemotherapy (NACT) exclusively in gallbladder cancer (GBC) are few and there are no randomized trials on the subject. Locally advanced GBC and indications for NACT in GBC are not yet clearly defined. METHODS: We analysed 160 consecutive GBC patients who received NACT based on clinico-radiologic criteria suggesting high-risk disease (TMH Criteria) from January 2010 to February 2016. RESULTS: On initial assessment, 140 (87.5%) patients had T3/T4 disease and 105 (65%) patients were node positive. Response rate and clinical benefit rate was 52.5% and 70% respectively. Sixty six (41.2%) patients could undergo curative intent resection. With a median follow-up of 33 months, the median OS and EFS of the entire cohort were 13 and 8 months respectively. Patient undergoing curative surgery had a statistically superior OS (49 vs. 7 months; p = 0.0001) and EFS (25 months vs. 5 months; p = 0.0001) compared to those who did not. CONCLUSION: Locally advanced GBC remains a disease with poor prognosis. Chemotherapy with neoadjuvant intent in locally advanced/borderline resectable GBC showed good response rates. This resulted in curative surgical resection or disease stabilisation in significant proportion of patients. Patients who undergo definitive surgery after favourable response to NACT experience good survival.
Authors: Muhammet Ozer; Suleyman Y Goksu; Nina N Sanford; Matthew Porembka; Hajra Khurshid; Chul Ahn; Mary Claire Maxwell; Muhammad Shaalan Beg; Syed M Kazmi Journal: JAMA Netw Open Date: 2022-02-01
Authors: Dana A Dominguez; John G Aversa; Brendan L Hagerty; Laurence P Diggs; Mustafa Raoof; Jeremy L Davis; Jonathan M Hernandez; Andrew M Blakely Journal: J Surg Oncol Date: 2020-08-11 Impact factor: 2.885