Concurrent chemoradiation for resected gall bladder cancers and cholangiocarcinomas

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Gallbladder cancer (GBC) and cholangiocarcinoma (CCA) are rare malignancies with poor prognoses.
• Definitive resection is a primary treatment modality for these cancers.
• The role of neoadjuvant therapy in improving outcomes for GBC and CCA remains under investigation.

Purpose of the Study:

• To compare treatment outcomes, including overall survival (OS), locoregional failure (LRF), and distant failure (DF), in patients with GBC and CCA.
• To evaluate the impact of neoadjuvant therapy (chemotherapy and/or radiation) versus no neoadjuvant treatment prior to definitive resection.

Main Methods:

• Retrospective analysis of 128 non-metastatic GBC and CCA patients who underwent definitive resection between 1992 and 2016.
• Comparison of OS, LRF, and DF between patients who received neoadjuvant therapy and those who did not.
• Statistical analysis using Kaplan-Meier, log-rank tests, and Cox proportional hazard models.

Main Results:

• No significant difference in median OS was observed between neoadjuvant and non-neoadjuvant groups for GBC (3.1 years vs. 2.6 years, P=0.6786) or CCA (2.0 years vs. 3.6 years, P=0.1613).
• A trend towards increased DF was noted in patients receiving neoadjuvant therapy for CCA (HR 2.74) and GBC (HR 0.92), though not statistically significant.
• Recurrence patterns differed, with a higher proportion of locoregional failures in the neoadjuvant group for GBC and distant failures in the neoadjuvant group for CCA.

Conclusions:

• Neoadjuvant therapy did not demonstrate a survival benefit in this retrospective cohort of GBC and CCA patients undergoing resection.
• A trend towards better survival was observed in adjuvantly treated CCA patients, but not in GBC patients.
• Differences in recurrence patterns suggest that treatment modality, patient selection, and unmeasured factors may influence outcomes.