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Neuroendocrine Carcinoma of Gallbladder: A Step Beyond Palliative Therapy, Experience of 25 Cases
Amol Vijay Kanetkar1, Shraddha Patkar1, Krunal Harischandra Khobragade1
1Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Dr E Borges Road, Parel, Mumbai, 400012, India.
Purpose:
Published literature on gall bladder neuroendocrine tumors (GB NETs) is limited with none reporting the role of multimodal therapy.
Methods:
Patients with histologically confirmed GB NETs treated at Tata Memorial Hospital, Mumbai, from January 2010 to June 2017 were analyzed. Staging was done by contrast-enhanced computed tomography (CECT) of abdomen and chest or a positron emission topography (PET) scan. Tumor marker (CA19-9) was measured. WHO-2017 guideline was used to classify GB NETs. GB NETs were categorized as early disease (ED) (T1, T2, N0, i.e., stages I and II); locally advanced disease (LAD) (T3, T4, or N+, i.e., stage III); and metastatic disease (MD). Response to treatment was assessed with RECIST1.1 criteria.
Results:
Twenty-five patients of GB NETs were identified; 19 with neuroendocrine carcinomas (NECs) and 6 with mixed adenoneuroendocrine carcinomas (MANECs). Two patients (8%) presented with ED, 9 (36%) with LAD, and 14 (56%) had MD. Those with ED underwent open revision radical cholecystectomy. Both received adjuvant chemotherapy (ACT) with six cycles of carboplatin-etoposide and were disease-free at 3 months of follow-up. Of the nine patients with LAD, six received three cycles of neoadjuvant chemotherapy (NACT) (carboplatin-etoposide) and three operated upfront. All six patients showed partial response to NACT and five underwent open radical cholecystectomy with R0 resection. All patients operated after NACT received three cycles of ACT. Their median follow-up was 7 months (range 3-22 months). Three patients with LAD developed metastasis after median disease-free survival of 5 months. The median survival in patients with MD was 12 (range 6-23) months.
Conclusions:
In carefully selected patients of GB NECs, downsizing with NACT facilitates radical resection with negative margins.
Insights
Multimodal therapy, including neoadjuvant chemotherapy (NACT), can facilitate radical resection for carefully selected gallbladder neuroendocrine carcinomas (GB NECs). This approach shows promise in improving outcomes for locally advanced disease.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Medical Oncology
Background:
- Gallbladder neuroendocrine tumors (GB NETs) are rare with limited published literature.
- The role of multimodal therapy in managing GB NETs has not been previously reported.
Purpose of the Study:
- To evaluate the role of multimodal therapy in managing gallbladder neuroendocrine tumors (GB NETs).
- To assess the efficacy of neoadjuvant chemotherapy (NACT) in facilitating radical resection for locally advanced GB NETs.
Main Methods:
- Retrospective analysis of 25 patients with histologically confirmed GB NETs treated between 2010 and 2017.
- Staging utilized contrast-enhanced computed tomography (CECT) or positron emission topography (PET) scans.
- Tumor classification followed WHO-2017 guidelines, categorizing disease as early (ED), locally advanced (LAD), or metastatic (MD).
Main Results:
- The study identified 19 neuroendocrine carcinomas (NECs) and 6 mixed adenoneuroendocrine carcinomas (MANECs).
- Two patients (8%) had ED, 9 (36%) had LAD, and 14 (56%) had MD.
- For LAD, neoadjuvant chemotherapy (carboplatin-etoposide) resulted in partial response in 6 patients, enabling R0 resection in 5 after surgery.
Conclusions:
- Neoadjuvant chemotherapy (NACT) can facilitate radical resection with negative margins in selected patients with gallbladder neuroendocrine carcinomas (GB NECs).
- Multimodal therapy represents a viable strategy for managing locally advanced GB NECs.
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