Superselective intra-arterial chemotherapy with mitomycin for gallbladder cancer

A group of 27 patients with carcinoma of the gallbladder was treated by superselective intra-arterial chemotherapy with mitomycin between 1981 and 1990. Results were compared with those in 22 historical controls. The overall response rate to intra-arterial chemotherapy was 48 per cent. The median survival time for responders was 34 months and for non-responders 8 months. Survival was significantly related to tumour stage in patients treated by chemotherapy (P < 0.001) and controls (P < 0.01); all patients with tumour extending beyond the serosa died within 4 years. The median survival period after intra-arterial chemotherapy was 14 months, compared with 4 months in controls. The cumulative 5-year survival rates for patients treated by chemotherapy and controls were not significantly different. Cessation of chemotherapy was required in 16 of the 27 patients: in eight because of tumour progression, in seven after toxicity to chemotherapy and in one because of patient refusal. Superselective intra-arterial chemotherapy can be useful for patients with cancer restricted to the gallbladder wall but cannot prevent tumour growth once this has extended beyond the gallbladder serosa.