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Evaluation of Adjuvant Radiation Therapy for Resected Gallbladder Carcinoma: A Multi-institutional Experience

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The role of adjuvant radiation for gallbladder carcinoma (GBC) is uncertain. We combine the experience of six National Cancer Institute-designated cancer centers to explore the impact of adjuvant radiation following oncologic resection of GBC.

Methods

Patients who underwent extended surgery for GBC at Johns Hopkins, Mayo Clinic, Duke University, Oregon Health & Science University, University of Michigan, and University of Texas MD Anderson between 1985 and 2008 were reviewed. Patients with metastatic disease at surgery, gross residual disease, or missing pathologic information were excluded.

Results

Of the 112 patients identified, 61 % received adjuvant radiation, 93 % of whom received concurrent chemotherapy. Median follow-up of surviving patients was 47.3 (range 2.2–167.7) months. Patients who received adjuvant radiation had a higher rate of advanced T-stage (57 vs. 16 %, p < 0.01), lymph node involvement (63 vs. 18 %, p < 0.01), and positive microscopic margins (37 vs. 9 %, p < 0.01) compared with patients managed with surgery alone, but overall survival (OS) was comparable between the two cohorts (5-year OS: 49.7 vs. 52.5 %, p = 0.20). Lymph node involvement had the strongest association with poor OS (p < 0.01). Adjuvant radiation was associated with decreased isolated local failure (hazard ratio 0.17, 95 % confidence interval 0.05–0.63, p = 0.01). However, 71 % of recurrences included distant failure.

Conclusions

Following oncologic resection for GBC, adjuvant radiation may offer improved local control compared with observation. The benefit of adjuvant radiation beyond chemotherapy alone should therefore be explored. Certainly, the high rate of distant failure highlights the need for more effective systemic therapy.

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Disclosure

Dr. Fuller received NIH funding support from the National Institute of Biomedical Imaging and Bioengineering Training Grant (5T32EB000817-04) and National Cancer Institute Clinician Scientist Loan Repayment Program (L30 CA136381). The remaining authors have no conflicts of interest or disclosures to report.

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Authors and Affiliations

  1. MD Anderson Cancer Center, Houston, TX, USA

    Jingya Wang MD, Clifton D. Fuller MD, PhD & Christopher H. Crane MD

  2. Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Amol K. Narang MD, Elizabeth A. Sugar PhD, Brandon Luber ScM, Lauren M. Rosati BS, Charles C. Hsu MD, PhD, Timothy M. Pawlik MD & Joseph M. Herman MD, MSc

  3. San Francisco School of Medicine, University of California, San Francisco, CA, USA

    Charles C. Hsu MD, PhD

  4. Uinversity of Texas Health Science Center, San Antonio, TX, USA

    Clifton D. Fuller MD, PhD & Charles R. Thomas Jr. MD

  5. The Mayo Clinic College of Medicine, Rochester, MN, USA

    Robert C. Miller MD, MS

  6. Duke University School of Medicine, Durham, NC, USA

    Brian G. Czito MD

  7. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Richard Tuli MD, PhD

  8. University of Michigan School of Medicine, Ann Arbor, MI, USA

    Edgar Ben-Josef MD

  9. Oregon Health & Science University, Portland, OR, USA

    Charles R. Thomas Jr. MD

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  1. Jingya Wang MD
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  2. Amol K. Narang MD
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  7. Clifton D. Fuller MD, PhD
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  10. Brian G. Czito MD
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  14. Charles R. Thomas Jr. MD
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  15. Joseph M. Herman MD, MSc
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Corresponding author

Correspondence to Joseph M. Herman MD, MSc.

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Wang, J., Narang, A.K., Sugar, E.A. et al. Evaluation of Adjuvant Radiation Therapy for Resected Gallbladder Carcinoma: A Multi-institutional Experience. Ann Surg Oncol 22 (Suppl 3), 1100–1106 (2015). https://doi.org/10.1245/s10434-015-4685-y

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  • DOI: https://doi.org/10.1245/s10434-015-4685-y

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