Patterns of Recurrence and Its Effective Treatment

Abstract

Gallbladder cancer is classified in biliary tract cancer, which also includes biliary duct and ampulla of Vater cancers. In patterns of metastases and recurrence of gallbladder cancer, lymphatic, liver via vascular, and peritoneal seeding are major metastatic ways in biliary tract cancer, including gallbladder cancer. Chemotherapy and/or radiotherapy are applied to unresectable gallbladder cancer. A comparative study between chemotherapy and supportive care in patients with unresectable pancreatic cancer and biliary tract cancer demonstrated that chemotherapy using fluorouracil plus leucovorin based regimens prolonged the survival. On the other hand, the role of radiation therapy remains unclear in the treatment of locally advanced but non-metastatic biliary tract cancer including gallbladder cancer. A phase III trial comparing gemcitabine (GEM) plus cisplatin (GC therapy) with GEM alone (ABC-02) demonstrated statistically significant longer survival, and GC therapy has been recognized as a standard of care for unresectable biliary tract cancer. A meta-analysis of two randomized trials of randomized controlled trials between GC therapy and GEM alone resulted in improved survival for intra- and extra-hepatic cholangiocarcinomas, gallbladder cancer, and ampullary cancer. GC plus another agent such as immune checkpoint inhibitor or targeted agents based on testing gene profiling such as fibroblast growth factor receptor 2 are currently under investigation to develop new agents for biliary tract cancer.