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226P Neoadjuvant chemotherapy in locally advanced gall bladder cancer : A retrospective tertiary care centre experience

In Annals of oncology
By: Sahu A [Corresponding author].
Contributor(s): Patkar S | Chaudhuri B | Shrikhande S | Goel M | Ramadwar M | Shetty N.
Material type: materialTypeLabelArticlePublisher: 2016Description: .Subject(s): Gastrointestinal tumours | Non-colorectal In: Annals of oncologySummary: Background: Only 10% of gall bladder cancers (GBC) present at an early-stage to be considered surgical candidates and for the rest the goal is palliation. Neoadjuvant chemotherapy (NACT) in locally advanced GBC remains an option still to be explored. Methods: This is a retrospective analysis of prospectively maintained data of 93 consecutive locally advanced GBC patients who were offered NACT with 3-4 cycles of Gemicitabine- Platinum based regimens (either oxaliplatin or cisplatin) between January 2013 to December 2015 at Tata Memorial Hospital. Locally advanced was defined as gall bladder (GB) mass invading liver > 2cm, GB mass adherent to pylorus, duodenum, hepatic flexure and pancreas, coeliac/gastrohepatic adenopathy/portocaval and peripancreatic nodes, bile duct invasion or porta hepatis invasion, vascular invasion – hepatic artery or portal vein, doubtful margin status if resection attempted and residual disease after laparoscopic cholecystectomy at an outside centre. The resectability rate and survival outcomes were analysed for these patients. Results: Median age of the cohort was 52 yrs (31 - 72). Male to female ratio was 1:3. Of 93 patients, 85 (91.3%) completed the scheduled number of cycles of NACT while it was stopped in 3 patients (3.2%) due to rapid clinical deterioration and 5 patients defaulted further follow up. The clinical benefit rate was 70.5%. The overall response rate was 50.6%. Thirty three of 93 patients underwent curative resection after NACT with a resection rate of 37.5%. The median follow up duration was 15 months. The median PFS for the whole cohort was 12.8 months with a 2 yr PFS of 30%. The median PFS of patients who underwent resection was 23 months as compared to 6 months of those who were inoperable (1 yr PFS – Resection done Vs inoperable – 76% Vs 20%; p value – 0.0001). The median overall survival was not reached for the whole cohort with 2yr OS of 57%. 2 yr overall survival in patients who underwent surgical resection as compared to those who were inoperable was 80% Vs 31%; p value – 0.0001. Conclusions: NACT gives a potential chance of cure by downstaging the tumor and making it amenable to resection. It is a feasible option with probable survival benefit which needs to be further evaluated in a larger set of patients.
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Background: Only 10% of gall bladder cancers (GBC) present at an early-stage to be considered surgical candidates and for the rest the goal is palliation. Neoadjuvant chemotherapy (NACT) in locally advanced GBC remains an option still to be explored.

Methods: This is a retrospective analysis of prospectively maintained data of 93 consecutive locally advanced GBC patients who were offered NACT with 3-4 cycles of Gemicitabine- Platinum based regimens (either oxaliplatin or cisplatin) between January 2013 to December 2015 at Tata Memorial Hospital. Locally advanced was defined as gall bladder (GB) mass invading liver > 2cm, GB mass adherent to pylorus, duodenum, hepatic flexure and pancreas, coeliac/gastrohepatic adenopathy/portocaval and peripancreatic nodes, bile duct invasion or porta hepatis invasion, vascular invasion – hepatic artery or portal vein, doubtful margin status if resection attempted and residual disease after laparoscopic cholecystectomy at an outside centre. The resectability rate and survival outcomes were analysed for these patients.

Results: Median age of the cohort was 52 yrs (31 - 72). Male to female ratio was 1:3. Of 93 patients, 85 (91.3%) completed the scheduled number of cycles of NACT while it was stopped in 3 patients (3.2%) due to rapid clinical deterioration and 5 patients defaulted further follow up. The clinical benefit rate was 70.5%. The overall response rate was 50.6%. Thirty three of 93 patients underwent curative resection after NACT with a resection rate of 37.5%. The median follow up duration was 15 months. The median PFS for the whole cohort was 12.8 months with a 2 yr PFS of 30%. The median PFS of patients who underwent resection was 23 months as compared to 6 months of those who were inoperable (1 yr PFS – Resection done Vs inoperable – 76% Vs 20%; p value – 0.0001). The median overall survival was not reached for the whole cohort with 2yr OS of 57%. 2 yr overall survival in patients who underwent surgical resection as compared to those who were inoperable was 80% Vs 31%; p value – 0.0001.

Conclusions: NACT gives a potential chance of cure by downstaging the tumor and making it amenable to resection. It is a feasible option with probable survival benefit which needs to be further evaluated in a larger set of patients.

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