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Adjuvant Radiotherapy After Surgery for Advanced Gallbladder Cancer

By: Kayci Reyer
Posted: Friday, September 30, 2022

According to research presented in Radiation Oncology, adjuvant treatments such as radiotherapy may benefit some patients with postoperative gallbladder cancer after surgery. Gallbladder cancer is associated with high rates of recurrence and metastasis, and postoperative recurrent patterns may provide critical insight into adjuvant treatment design.

“Up to 75% of the recurrent cases occurred in the potential target volume of postoperative radiotherapy, suggesting that postoperative radiotherapy has the possible value of improving local-regional control,” concluded Qichun Wei, PhD, of the Zhejiang University School of Medicine, Hangzhou, China, and colleagues. “The potential target volume of radiotherapy should include the tumor bed, No. 8, No. 9, No. 11, No. 12, No. 13, No. 14, No. 16a2, No. 16b1 lymph node groups.”

The retrospective study analyzed the records of 109 patients with gallbladder cancer who were surgically treated between 2013 and 2018. Of the 54 recurrent cases identified during a median follow-up of 34 months, 40 had detailed sites of recurrence, which were categorized as tumor bed, corresponding lymphatic drainage area, intrahepatic recurrence, and distant metastasis.

Median disease-free survival was 48.8 months, and median overall survival was 53.7 months. Tumor markers; hepatic, perineural, or lymphovascular invasion; tumor, nodes, and metastases (TNM) staging; and tumor differentiation were identified via univariate analysis as risk factors for disease-free and overall survival. Multivariate analysis revealed TNM staging to be a risk factor for both survival measures. Hepatic invasion was also identified as a risk factor for disease-free survival.

A total of 29 patients (72.5%) with specific sites of recurrence experienced recurrence in the potential target volume of postoperative radiotherapy, such as the tumor bed and corresponding lymphatic drainage area. Of those recurrences, 20 occurred along with distant metastasis, bringing the total number of patients experiencing distant metastasis to 31 (77.5%). Lymph node groups commonly associated with recurrence included para-aortic, hepatoduodenal ligament, retropancreatic head, and celiac axis lymph nodes.

Disclosure: The study authors reported no conflicts of interest.

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