Abstract
To evaluate the benefit of adjuvant treatments, such as chemoradiotherapy (CRT) and chemotherapy (CTx), compared with no adjuvant treatment (No-AT) in resected gallbladder (GB) cancer patients, 151 patients were analyzed: 98 (64.9%) patients received adjuvant treatment with CRT (n = 59, 39.1%) or CTx (n = 39, 25.8%), and the remaining 53 (35.1%) did not (No-AT). The clinicopathological factors, patterns of failure, locoregional recurrence-free survival (LRFS), recurrence-free survival (RFS) and overall survival (OS) were compared among the three groups according to tumor stage. In patients with T2-3N0M0 stage disease, the incidences of locoregional recurrence and distant recurrence and 5-year LRFS, RFS and OS rates were not significantly different among the No-AT, CTx, and CRT groups (p > 0.05 each). In those with T2-3N1-2M0 stage disease, the incidences of locoregional recurrence (11.4%, 78.1%, and 68.4%, respectively) and distant recurrence (42.8%, 73.9% and 66.7%, respectively) in the CRT group were significantly lower than those in the No-AT and CTx groups (p < 0.05), and the CRT group had significantly higher 5-year LRFS (82,1%, 26.8%, and 19.0%), RFS (53.3%, 11.6% and 16.7%) and OS rates (64.0%, 22.7% and 4.3%) than the CTx and No-AT groups (p < 0.05 each). Therefore, adjuvant CRT may improve the LRFS and RFS and subsequently improve OS in lymph node-positive resected GB cancer.
Highlights
T classification N classification Total no. of dissected LNs Preop carbohydrate 19-9 (CA 19-9) level (U/mL) Postop CA 19-9 level (U/mL) Histologic differentiation Resection margin Vascular invasion Lymphatic invasion Perineural invasion
In the CRT group, a median radiation dose of 50.4 Gy, 1.8 Gy/fraction was delivered to the planning target volume (PTV) using three-dimensional conformal radiotherapy techniques with four or five coplanar beams of 15 MV photons, and concomitant 5-FU-based chemotherapy was administered
The clinical target volume (CTV) included regional lymph nodes, including the porta hepatis, peripancreatic, celiac, origin of the superior mesenteric artery and para-aortic nodes, with or without a primary tumor bed, and the PTV was defined as the CTV plus 10–20 mm in the craniocaudal direction and 7–10 mm in the other directions to compensate for the setup- and respiration-related uncertainties
Summary
The aim of the present study was to evaluate the benefit of adjuvant treatments, such as CRT and CTx, compared with that of surgery alone in resected GB cancer patients
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