Outcome of neoadjuvant chemotherapy in “locally advanced/borderline resectable” gallbladder cancer: the need to define indications
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. We analysed 160 consecutive GBC patients who received NACT based on...
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| Published in | HPB (Oxford, England) Vol. 20; no. 9; pp. 841 - 847 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Elsevier Ltd
01.09.2018
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1365-182X 1477-2574 1477-2574 |
| DOI | 10.1016/j.hpb.2018.03.008 |
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| Abstract | 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.
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.
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.
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. |
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| AbstractList | 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.
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.
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.
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. 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.BACKGROUNDStudies 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.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.METHODSWe 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.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.RESULTSOn 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.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.CONCLUSIONLocally 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. |
| Author | Chaudhari, Vikram A. Patkar, Shraddha Shetty, Nitin S. Ramaswamy, Anant Goel, Mahesh Sahu, Arvind Ostwal, Vikas Toshniwal, Anup Shrikhande, Shailesh V. |
| Author_xml | – sequence: 1 givenname: Vikram A. surname: Chaudhari fullname: Chaudhari, Vikram A. organization: GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India – sequence: 2 givenname: Vikas surname: Ostwal fullname: Ostwal, Vikas organization: Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India – sequence: 3 givenname: Shraddha surname: Patkar fullname: Patkar, Shraddha organization: GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India – sequence: 4 givenname: Arvind surname: Sahu fullname: Sahu, Arvind organization: Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India – sequence: 5 givenname: Anup surname: Toshniwal fullname: Toshniwal, Anup organization: Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India – sequence: 6 givenname: Anant surname: Ramaswamy fullname: Ramaswamy, Anant organization: Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India – sequence: 7 givenname: Nitin S. surname: Shetty fullname: Shetty, Nitin S. organization: Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India – sequence: 8 givenname: Shailesh V. surname: Shrikhande fullname: Shrikhande, Shailesh V. organization: GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India – sequence: 9 givenname: Mahesh surname: Goel fullname: Goel, Mahesh email: drmaheshgoel@gmail.com organization: GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India |
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| Snippet | Studies evaluating neo-adjuvant chemotherapy (NACT) exclusively in gallbladder cancer (GBC) are few and there are no randomized trials on the subject. Locally... |
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| SubjectTerms | Adult Aged Chemotherapy, Adjuvant Cholecystectomy - adverse effects Cholecystectomy - mortality Databases, Factual Female Gallbladder Neoplasms - diagnostic imaging Gallbladder Neoplasms - mortality Gallbladder Neoplasms - pathology Gallbladder Neoplasms - therapy Humans Lymphatic Metastasis Male Middle Aged Neoadjuvant Therapy - adverse effects Neoadjuvant Therapy - mortality Neoplasm Staging Retrospective Studies Risk Factors Time Factors Treatment Outcome |
| Title | Outcome of neoadjuvant chemotherapy in “locally advanced/borderline resectable” gallbladder cancer: the need to define indications |
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