Patterns of initial failure after resection for gallbladder cancer: implications for adjuvant radiotherapy

다국어 초록 (Multilingual Abstract)

Purpose: This study sought to identify potential candidates for adjuvant radiotherapy and patterns of regional failure in patients who underwent curative-intent surgery for gallbladder cancer.
Materials and Methods: Records for 70 patients with gallbladder cancer who underwent curative resection at a single institution between 2000 and 2016 were analysed retrospectively. No patients received adjuvant radiotherapy. Initial patterns of failure were evaluated. Regional recurrence was categorized according to the definitions of lymph node stations suggested by the Japanese Society of Hepato-Biliary-Pancreatic Surgery.
Results: Median follow-up was 23 months. Locoregional recurrence as any component of first failure occurred in 29 patients (41.4%), with isolated locoregional recurrence in 13 (18.6%). Regional recurrence occurred in 23 patients, and 77 regional recurrences were identified. Commonly involved regional stations were #13, #12a2, #12p2, #12b2, #16a2, #16b1, #9, and #8.
Independent prognostic factors for locoregional recurrence were ≥pT2 disease (hazard ratio [HR], 5.510; 95% confidence interval [CI], 1.260–24.094; p = 0.023) and R1 resection (HR, 6.981; 95% CI, 2.378–20.491; p < 0.001).
Conclusion: Patients with pT2 disease or R1 resection after curative surgery for gallbladder cancer may benefit from adjuvant radiotherapy. Our findings on regional recurrence may help physicians construct a target volume for adjuvant radiotherapy.

참고문헌 (Reference)

1 배진숙, "The role of surgical clips in the evaluation of interfractional uncertainty for treatment of hepatobiliary and pancreatic cancer with postoperative radiotherapy" 대한방사선종양학회 35 (35): 65-70, 2017

2 Sikora SS, "Surgical strategies in patients with gallbladder cancer: nihilism to optimism" 93 : 670-681, 2006

3 Ben-Josef E, "SWOG S0809: a phase II intergroup trial of adjuvant capecitabine and gemcitabine followed by radiotherapy and concurrent capecitabine in extrahepatic cholangiocarcinoma and gallbladder carcinoma" 33 : 2617-2622, 2015

4 Kim WS, "Risk factors influencing recurrence, patterns of recurrence, and the efficacy of adjuvant therapy after radical resection for gallbladder carcinoma" 14 : 679-687, 2010

5 Margonis GA, "Rates and patterns of recurrence after curative intent resection for gallbladder cancer: a multi-institution analysis from the US Extra-hepatic Biliary Malignancy Consortium" 18 : 872-878, 2016

6 Abramson MA, "Radical resection for T1b gallbladder cancer: a decision analysis" 11 : 656-663, 2009

7 Wang SJ, "Prediction model for estimating the survival benefit of adjuvant radiotherapy for gallbladder cancer" 26 : 2112-2117, 2008

8 이승은, "Practical Guidelines for the Surgical Treatment of Gallbladder Cancer" 대한의학회 29 (29): 1333-1340, 2014

9 Jeong Y, "Postoperative radiotherapy for gallbladder cancer" 34 : 5621-5629, 2014

10 김미영, "Postoperative radiotherapy appeared to improve the disease free survival rate of patients with extrahepatic bile duct cancer at high risk of loco-regional recurrence" 대한방사선종양학회 34 (34): 297-304, 2016

11 Jarnagin WR, "Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma: implications for adjuvant therapeutic strategies" 98 : 1689-1700, 2003

12 Jung SJ, "Patterns of initial disease recurrence after resection of biliary tract cancer" 83 : 83-90, 2012

13 Park HS, "Outcome of adjuvant therapy for gallbladder cancer" 79 : 168-173, 2010

14 Glazer ES, "Neither neoadjuvant nor adjuvant therapy increases survival after biliary tract cancer resection with wide negative margins" 16 : 1666-1671, 2012

15 Itoh H, "Magnitude of combination therapy of radical resection and external beam radiotherapy for patients with carcinomas of the extrahepatic bile duct and gallbladder" 50 : 2231-2242, 2005

16 Mitin T, "Limited use of adjuvant therapy in patients with resected gallbladder cancer despite a strong association with survival" 109 : djw324-, 2017

17 Miller G, "Gallbladder carcinoma" 34 : 306-312, 2008

18 Hundal R, "Gallbladder cancer: epidemiology and outcome" 6 : 99-109, 2014

19 Randi G, "Gallbladder cancer worldwide: geographical distribution and risk factors" 118 : 1591-1602, 2006

20 Fong Y, "Evidence-based gallbladder cancer staging: changing cancer staging by analysis of data from the National Cancer Database" 243 : 767-774, 2006

21 Williams TM, "Defining the role of adjuvant therapy: cholangiocarcinoma and gall bladder cancer" 24 : 94-104, 2014

22 Marinelli I, "Clinical target volume in biliary carcinoma: a systematic review of pathological studies" 37 : 955-961, 2017

23 Miyazaki M, "Classification of biliary tract cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery: 3(rd) English edition" 22 : 181-196, 2015

24 Mantripragada KC, "Adjuvant therapy for resected gallbladder cancer: analysis of the National Cancer Data Base" 109 : djw202-, 2016

25 Gold DG, "Adjuvant therapy for gallbladder carcinoma: the Mayo Clinic Experience" 75 : 150-155, 2009

26 Mallick S, "Adjuvant radiotherapy in the treatment of gall bladder carcinoma: what is the current evidence" 28 : 1-6, 2016

27 Sun XN, "Adjuvant radiotherapy for gallbladder cancer: a dosimetric comparison of conformal radiotherapy and intensity-modulated radiotherapy" 17 : 397-402, 2011

28 Mojica P, "Adjuvant radiation therapy is associated with improved survival for gallbladder carcinoma with regional metastatic disease" 96 : 8-13, 2007