Scholarlink

Background <p>Since GBC usually presents as unresectable disease, we conducted a prospective observational study to evaluate the effect of neoadjuvant strategies (NAT) on radiologic downstaging and resectability.</p> Materials and Methods <p>Patients with locally advanced GBC were treated with neoadjuvant chemotherapy (NACT). Those who were unresectable after 4–6 cycles NACT were offered consolidation chemoradiotherapy [CTRT] (45&#xa0;Gy along with weekly concurrent cisplatin, 5FU [prior to 2014] and thereafter concurrent capecitabine@1250mg/<sup>2</sup>). Radiological assessment of response to chemotherapy was done (by CT angiography and PET-CT) to evaluate for resectability. Features affecting resectability were evaluated. Those found suitable for resection underwent radical surgery.</p> Results <p>217 patients were evaluated (January 2012 to December 2022) (NACT:60%, NACT followed by CTRT:40%,). Pretreatment CT scans revealed involvement of liver&gt;2&#xa0;cm (75%), duodenum (42%), colon (29%), CBD (36%), CHD/primary confluence (45.6%), Hepatic Artery (32%), portal vein (21%), N0 (24.5%) N1 (17%), N2 (17%), retroperitoneal LN ( 40%). After NACT considerable radiological downstaging was evident in liver, duodenum and colon involvement (52%, 40% and 37%), while downstaging in CBD, CHD/confluence was relatively rare (14%, 7%). The proportion of nodal downstaging was evident from increase in proportion of N0 and N1 (37.5%, 20%), and decrease in proportion of N2 and RPLN (8%, 20%). Only 22 patients (10%) underwent surgical resection (EC <i>n</i> = 21, SC <i>n</i> = 1, after NACT:12, after CTRT:10). All except two were R0 (91%) and 48% had ypN0 disease. The median OS of those who underwent resection is 49 months (95% CI 26.8–69 mo.) versus 9 months (95% CI 8–10 mo.) in those who did not.</p> Conclusions <p>NAT in unresectable GBC results in 10% resectability rate. Patients with liver involvement, duodenal involvement and lymphadenopathy had greater possibility of resectability after NAT, whereas those with biliary tree or vessel involvement had least possibility of resection. This approach has a potential of achieving R0, node negative disease leading to improved survival rates and should be actively explored in patients without biliary and vessel involvement.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Neoadjuvant Treatment Strategies in Unresectable Gallbladder Cancer (GBC) in a Regional Cancer Centre in India: a Prospective Cohort Study

  • 期刊论文

  • 发表日期：

    2026年4月13日

查看全文
  • Sushma Agrawal,
  • Rahul Rahul,
  • Ashish Singh,
  • Rajan Saxena

摘要

Background

Since GBC usually presents as unresectable disease, we conducted a prospective observational study to evaluate the effect of neoadjuvant strategies (NAT) on radiologic downstaging and resectability.

Materials and Methods

Patients with locally advanced GBC were treated with neoadjuvant chemotherapy (NACT). Those who were unresectable after 4–6 cycles NACT were offered consolidation chemoradiotherapy [CTRT] (45 Gy along with weekly concurrent cisplatin, 5FU [prior to 2014] and thereafter concurrent capecitabine@1250mg/2). Radiological assessment of response to chemotherapy was done (by CT angiography and PET-CT) to evaluate for resectability. Features affecting resectability were evaluated. Those found suitable for resection underwent radical surgery.

Results

217 patients were evaluated (January 2012 to December 2022) (NACT:60%, NACT followed by CTRT:40%,). Pretreatment CT scans revealed involvement of liver>2 cm (75%), duodenum (42%), colon (29%), CBD (36%), CHD/primary confluence (45.6%), Hepatic Artery (32%), portal vein (21%), N0 (24.5%) N1 (17%), N2 (17%), retroperitoneal LN ( 40%). After NACT considerable radiological downstaging was evident in liver, duodenum and colon involvement (52%, 40% and 37%), while downstaging in CBD, CHD/confluence was relatively rare (14%, 7%). The proportion of nodal downstaging was evident from increase in proportion of N0 and N1 (37.5%, 20%), and decrease in proportion of N2 and RPLN (8%, 20%). Only 22 patients (10%) underwent surgical resection (EC n = 21, SC n = 1, after NACT:12, after CTRT:10). All except two were R0 (91%) and 48% had ypN0 disease. The median OS of those who underwent resection is 49 months (95% CI 26.8–69 mo.) versus 9 months (95% CI 8–10 mo.) in those who did not.

Conclusions

NAT in unresectable GBC results in 10% resectability rate. Patients with liver involvement, duodenal involvement and lymphadenopathy had greater possibility of resectability after NAT, whereas those with biliary tree or vessel involvement had least possibility of resection. This approach has a potential of achieving R0, node negative disease leading to improved survival rates and should be actively explored in patients without biliary and vessel involvement.