RADIATION THERAPY IN GALLBLADDER CARCINOMA: THE FOX CHASE CANCER CENTER EXPERIENCE

1
RADIATION THERAPY IN GALLBLADDER CARCINOMA

THE FOX CHASE CANCER CENTER EXPERIENCE
Niraj H. Pahlajani1, Karen Ruth1, Gary M.
Freedman1, Neal J. Meropol2, Steven J. Cohen2,
J.Chris Watson3, John P. Hoffman3, Andre A.
Konski1 1 Department of Radiation Oncology, Fox
Chase Cancer Center, Philadelphia, PA, USA 2
Department of Medical Oncology, Fox Chase Cancer
Center, Philadelphia, PA, USA3 Department of
Surgical Oncology, Fox Chase Cancer Center,
Philadelphia, PA, USA
Definitive Radiation vs. SurgeryRadiation
Preoperative vs. Postoperative
OBJECTIVE Surgery is widely used for the
treatment of gallbladder cancer with curative
intent. The role of radiation, however, remains
poorly defined. We retrospectively reviewed the
Fox Chase Cancer Center experience to determine
prognostic variables for relapse-free and overall
survival (RFS and OS) in a cohort of patients
with primary gallbladder cancer treated with
radiation in the definitive, neoadjuvant or
adjuvant setting.
Overall Survival
Relapse Free Survival
Overall
Survival
Survival ()
Survival ()

• METHODS AND MATERIALS
• PATIENTS
• 23 patients with gallbladder cancer
• All received radiotherapy from 1985 to 2006
• -Charts were retrospectively reviewed for
  patient, tumor, and treatment characteristics

Months

Months

Months
Effect of
Pathologic Margin Status
Preoperative vs.
Postoperative
 
Overall Survival
Relapse Free Survival
Relapse
Free Survival
 
RESULTS
Table 1 Patient characteristics
 



Months

Months
Months

Figure 1 Survival by treatment Surgically
treated patients had the best OS and RFS. A
negative margin significantly predicted OS and
RFS, with 5 year rates of 67 and 43,
respectively. Preoperative radiation had similar
rates of OS and RFS compared to postoperative
radiation. Factors that did not affect outcome
were second surgery, extended surgical
procedure, radiation dose, AJCC stage, T-stage
and N-stage (data not shown).

• CONCLUSION
• Limitations of this study include small patient
  numbers, selection bias, the use of clinical
  staging for non-surgical patients, and that it
  was a single institution retrospective analysis.
• Given these limitations, this experience is
  consistent with other reports that surgery plays
  a major role in gallbladder cancer and that
  margin status was a strong predictor of RFS and
  OS.
• Trimodality therapy affords excellent rates of
  long term survival of 67 in patients with
  negative margins.

Table 2 Cox multivariate analysis (MVA)
Covariates included surgical margin, T-stage
(T1,2 vs T3,4), surgery (Yes/No), number of
surgeries (1 vs. 2), surgical extent (extended
vs. simple cholecystectomy), RT dose (54-60 Gy
and 45-50 Gy vs. 50.4 Gy), and sequence of
radiation (preoperative vs. postoperative).