Chemotherapy (CT) or chemoradiation (CTRT) in postoperative (simple cholecystectomy) carcinoma gall bladder (GBC) with residual disease, unsuitable for revision surgery.

Abstract

e15594 Background: Approximately 25% patients of GBC present after SC. Revision surgery is the standard of care, which is possible only in few patients because of delayed presentation ( > 3 months after SC), major vessels encasement by residual lymph-nodes or medical reasons. It is unclear whether these patients should be offered CT /CTRT/ CT followed by consolidation CTRT. The purpose of this analysis is to evaluate whether single modality or dual modality is required in these patients. Methods: Records of GBC patients with SC (non-metastatic based on a staging CECT abdomen) registered between January 2008 - December 2016 were retrieved. Based on the presence and extent of residual disease, they were risk stratified into 3 groups: (1) No residual disease [NRD], (2) LR1: residual disease in GB bed, peri-portal and peri-choledochal lymph-nodes, (3) LR2: residual disease in GB bed, peri-portal and peri-choledochal, coeliac, superior mesenteric or paraaortic lymph-nodes. Patients were either offered CT or CTRT due to lack of any guidelines and according to physician discretion. Those receiving CT were offered 6 cycles of Cisplatin and Gemcitabine. Patients in Consolidation CTRT arm received 3-4 cycles of Cisplatin and Gemcitabine followed by consolidation CTRT (Concurrent Capecitabine daily with RT upto 50.4Gy/28#/5.5 weeks). Response assessment was according to RECIST criteria (CR, PR, SD, PD). Overall survival (OS) was computed by Kaplan Meier method. Results: Out of 300 patients with SC, 87 had the inclusion criteria mentioned above and rest were metastatic. At a median follow-up of 21 months (range 2-129 months), the median OS was not reached (NR) for NRD (n = 17) ( both CT and CTRT), 19 months for LR1 (n = 33) (27 mo with CTRT and 19 mo with CT, p = 0.003) and 14 months for LR2 (14 mo with CTRT and 18 mo with CT, p = 0.29). The median OS was NR, 17 mo, 16 mo and 9 mo for CR (n = 30), PR(n = 31), SD (n = 5), PD (n = 5), p = 0.001. Conclusions: While NRD should be offered single modality, Consolidation CTRT benefits LR1 but not LR2. Risk stratification according to residual disease burden after SC is a prognostic marker for OS.