Locally advanced cases of Ca Gall Bladder : Is concurrent CT+RT beneficial in improving survival

Dr Saroj Saugat; Dr T Kothari; Dr Pramila Kumari; Dr N. Sharma; Dr H.S.Kumar

Volume : VI, Issue : IV, April - 2017

Locally advanced cases of Ca Gall Bladder : Is concurrent CT+RT beneficial in improving survival

Dr Saroj Saugat, Dr T Kothari, Dr Pramila Kumari, Dr N. Sharma, Dr H. S. Kumar

Abstract :

Background: Gall bladder carcinoma (GBC) is considered the fifth most common one of the most aggressive gastro intestinal tract malignancies. Over the years surgical resection has been considered the only curative treatment of these tumours. , even after curative surgery, survivals are dismal and loco–regional failure accounts for 40–86%. Although these are considered radio–resistant, adjuvant radiation, with or without chemotherapy, has been tried to improve loco–regional control and overall survival rates. With an aim to evaluate acute and late toxicity and efficacy of adjuvant chemo–radiation (CRT) after curatively resected GBC.

Materials and Methods: We retrospectively analyzed the cohort of patients diagnosed from 2010 to 2015, treated with adjuvant CRT at our institution. Treatment protocol considered external beam radiation (RT) (45–50 Gy) to tumor bed and regional lymph nodes with concurrent Cisplatin (40mg/m ² /weekly infusion one hour before radiotherapy). Data was obtained from medical records, mortality from death certificates. Survival was estimated by Kaplan– Meier curves.

Results: 46 patients with curatively resected GBC received adjuvant CRT. Median age was 57 years (range 33–76); 42 patients were female. After diagnosis, a second surgery was performed in 42 patients. Cholecystectomy with hepatic segmentectomy and lymphadenectomy was the curative surgery in 41 patients. All patients received RT with a planned dose of 50 Gy in 25 fractions, and 34 patients had concurrent Cisplatin. Therapy was well tolerated. Five patients experienced grade 3 toxicities. No grade 4 or 5 toxicity was observed. No grade >2 late toxicity was observed. Three– and 5–year overall survival (OS) were 51 and 36%, respectively

.Conclusions: Adjuvant chemo radiation is well tolerated and might impact favourably on survival in patients with curatively resected GBC.