Radiological downstaging with neoadjuvant therapy in unresectable gall bladder cancers

Aim/Background

Gallbladder cancer is endemic in the Indogangetic belt and often present as unresecatble or metastatic disease.We conducted a prospective feasibility study to evaluate the effect of neoadjuvant therapy on radiologic downstaging and resectability.We report our prelimnary results on radiologic downstaging in a cohort of patients.

Methods

Patients with locally advanced,unresectable gallbladder cancer were offered chemoradiotherapy [CTRT] ( external radiotherapy (45Gy) along with weekly concurrent cisplatin 35mg/m² and 5-FU 500 mg).Since patient recruitment was not as per our expectations and many presented with paraaortic lymphnodes, we included these patients as well and offered them neoadjuvant chemotherapy [CT} (cisplatin 25mg/m² and gemcitabine 1gm/m² day 1 and 8, 3 weekly for 3 cycles).Radiological downstaging was evaluated by downstaging of liver involvement and lymphadenopathy according to RECIST criteria.

Results

40 patients have been inducted into this study from January 2012 to December 2014.Few patients (n = 9) deteriorated on treatment and hence 2 sets of CT scans for response assessment was available for 31 patients.The pretreatment CT scans revealed involvement of porta hepatis (19), liver infiltration (38), duodenum involvement (n = 22), colon involvement (n = 11),N1 involvement (n = 11), N2 disease (n = 8),paraaortic LN (n = 15), no LN (n = 6). After neoadjuvant therapy ( CTRT = 19, CT = 21), liver involvement completely disappeared in 12(30%), partially in 17(42.5%),was static in 9 (5%) and lymphnode involvement completely disappeared in 20 (50%), partially in 7(17.5%),was static in 4 (10%).6 patients could undergo extended cholecystectomy who had 50% and 66% downstaging of liver and lymphnodes which translated into 74% and 84% histopathological downstaging of liver and lymphnodes.All resctions were R0.

Conclusions

Neoadjuvant therapy in unresectable gall bladder cancer results in 15% resectability rate and radiologic downstaging of liver by 72.5% and lymphadenopathy by 67.5% .Our prelimnary results reveal strong potential of this approach in achieving R0 and node negative disease.

Clinical trial identification

Disclosure

All authors have declared no conflicts of interest.