Adjuvant Radiotherapy after Surgical Resection for Gallbladder Cancer

Abstract

Purpose/Objective(s): To analyze the outcome of adjuvant radiotherapy for patients with gallbladder cancer who had undergone surgical resection, and to identify the prognostic factors for these patients. Materials/Methods: Between July 1990 and August 2006, 48 patients with gallbladder cancer underwent surgical resection followed by adjuvant radiotherapy. There were 21 males and 27 females, and median age was 60 years (range; 44-75). Postoperative radiotherapy was delivered to tumor bed and regional lymph nodes up to 40-50 Gy at 2 Gy per fraction. Forty-one patients also received intravenous 5-fluorouracil as a radiosensitizer. Median follow-up duration was 25 months for all patients, and 44 months for survivors. Results: There were 2 isolated loco-regional recurrences, 13 isolated distant metastases, and 8 combined loco-regional and distant relapses. Among 42 patients without gross residuum, there were only 4 loco-regional recurrences. The 5-year overall survival rate (OS) was 42.0%, and median survival time was 30 months. According to the extent of resection, the 5-year OS was 51.8%, 0%, and 0% in R0-, R1-, and R2-resected patients, respectively (p = 0.0012). Patients with T3-4 disease had an inferior 5-year OS compared with those with T2 disease (35.0% vs. 53.5%, p = 0.0781), whereas treatment outcome was comparable between node-negative and node-positive disease (5-year OS, 41.2% vs. 49.0%, p = 0.9132). On multivariate analysis incorporating performance status, extent of resection, T stage, N stage, and histologic differentiation, extent of resection was the only prognostic factor associated with overall survival (p = 0.0034). Conclusions: Adjuvant radiotherapy after R0 resection can achieve a long term survival rate in gallbladder cancer patients, even in those with lymph node metastases.