Results of adjuvant chemoradiation for gall bladder carcinoma: An institutional experience.

Abstract

288 Background: Adjuvant chemoradiation for gall bladder carcinoma is not a well established treatment modality. Methods: We retrospectively analysed our database between 2000 and 2011. All patients underwent surgery followed by adjuvant chemoradiation. The radiation dose was 45 Gy in 25 fractions planned by either conventional (2D) or 3 dimensional conformal radiation therapy (3D). Adjuvant chemotherapy was either Gemcitabine or 5 FU/leucovorin based. Log-rank test was used to compare survival distribution. The data was analysed using SPSS 16. Results: 75 patients were analysed. The median age was 48 years (range: 22 to 75 years). 16 males & 59 females were noted. 37 had well differentiated carcinoma while 38 had moderately differentiated carcinoma. The stage was IIIA or less in 45 patients and IIIB or more in 25 patients while it was unknown in 5. No patient had metastatic disease at presentation. 17 patients had a simple cholecystectomy, 57 had a radical cholecystectomy while status was unknown for 1. 25 patients had node negative disease while 50 had node positive disease. All patients received the prescribed radiation. 18 patients had 2D while 57 patients had 3D radiation. 13 patients had Gemcitabine based chemotherapy while 36 patients had 5 FU/leucovorin based chemotherapy. The status of chemotherapy was unknown for 26 patients. The median follow up was 12.7 months (range: 0 to 99 months). 22 patients relapsed. 2 patients had locoregional failure, 18 had distant failure while 2 had both locoregional & distant failure. The relapse free survival at 2 years was 57% and at the end of 6 years was 34%. Relapse free survival was significantly better for radical cholecystectomy vs. simple cholecystectomy (relapse free survival at 2 years 59.2% vs. 30.2 %; p = 0.054 on univariate analysis and relapse free survival at 2 years, 60% vs. 30%; p = 0.035 on multivariate analysis). Gender, tumor differentiation, nodal status, radiation technique and type of chemotherapy did not correlate with relapse free survival. Conclusions: Adjuvant chemoradiation resulted in excellent locoregional control. Radical surgery is an important factor for relapse free survival.