Radiological Downstaging with Neoadjuvant Therapy in Unresectable Gall Bladder Cancer Cases

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Gallbladder cancer (GBC) often presents as unresectable or metastatic disease, posing significant treatment challenges.
• Evaluating neoadjuvant therapy (NAT) is crucial for improving outcomes in these advanced cases.

Purpose of the Study:

• To assess the feasibility of neoadjuvant therapy (NAT) in unresectable gallbladder cancer (GBC).
• To evaluate the impact of NAT on radiologic downstaging and resectability rates.

Main Methods:

• Patients with locally advanced GBC received either chemoradiotherapy (CTRT) or neoadjuvant chemotherapy (NACT).
• Radiological assessments used RECIST criteria to evaluate downstaging of liver involvement and lymphadenopathy.
• Treatment regimens included external radiotherapy with cisplatin and 5-FU (CTRT) or cisplatin and gemcitabine (NACT).

Main Results:

• Out of 40 patients, 25 received CTRT and 15 received NACT.
• Post-NAT, significant radiologic downstaging was observed: 40.5% for liver involvement and 67.5% for lymphadenopathy.
• Six patients (15%) underwent extended cholecystectomy with R0 resection, achieving 66.6% and 83% downstaging of liver and lymph nodes, respectively.

Conclusions:

• Neoadjuvant therapy offers a 15% resectability rate for unresectable GBC, with potential for R0 resection and node-negative disease.
• Radiologic downstaging of liver involvement (40.5%) and lymphadenopathy (67.5%) is achievable with NAT.
• Nodal regression following NAT may predict treatment response in GBC.