Management of gallbladder cancer - experience of medical oncology department about 140 cases

Abstract

Introduction: Gallbladder cancer is a rare malignancy of the biliary tract with a poor prognosis with survival at 5 years not exceeding 5%. It is frequently presenting at an advanced stage because of a vague and nonspecific early symptomatology. The aim of this work is to study the main epidemiological, pathological, paraclinical and therapeutic aspects of this pathology. Methods: It is a retrospective study including all cases of histologically proven primary cancers of the gallbladder in the medical oncology department at Hassan II university hospital of Fez, Morocco, over the period from January 2010 to July 2018. Results: During the period of study, 140 patients were reported. The mean age at the time of diagnosis was 60 years with a clear female predominance (76%). Symptomatology was dominated by hepatic colic (89%) and jaundice (46%). At histopathological examination, adenocarcinoma was found in 87% of patients, squamous cell carcinoma in 13% of cases and neuroendocrine tumor in one patient. The staging assessment was based on thoracoabdominopelvic CT scan: localized stage represented only 6% of cases; locally advanced stage in 14% and metastatic stage was dominant with 80% of cases. Nine patients (6%) with localized disease underwent complete resection and received adjuvant treatment when T4 or node positive.Twenty patients underwent palliative surgical treatment: cholecystectomy of cleanliness (n = 7) and bilio-digestive bypass (n = 13). 10 patients have undergone endoscopic biliary prostheses. For metastatic patients, first-line chemotherapy was based on cisplatin and gemcitabine that was administered in 34% of patients. 14% had received chemotherapy with GEMCITABINE in monotherapy because of performance status (2-3) and/or unfitness to cisplatin, while 13% received gemcitabine combined with oxaliplatin(GEMOX). The objective response rate was 16%. After a median follow-up of 08 months: Overall survival was 7 months and progression-free survival was 2.5 months. Conclusion: Biliary tract cancers have a non-negligible incidence by being the fifth of digestive cancer. The poor prognosis of our patients is mainly related to the juxta-hepatic and para-pedicular situation of tumors and the difficulties of an early diagnosis. Conventional chemotherapy is still the mainstay treatment in the lack of new targeted therapies. Therefore, further research is needed to improve the outcome of patients.