title: Chemotherapy in the treatment of advanced gallbladder cancer.
abstract: OBJECTIVE
  To clarify the role of chemotherapy for advanced gallbladder cancer (GBC).
  
  
  METHODS
  We reviewed 89 GBC patients: 21 admitted before 1997 were treated with a combination of cisplatin, epirubicin, and 5-fluorouracil (CEF); 25, admitted subsequently, received a combination of 5-fluorouracil, doxorubicin and mitomycin (FAM), and the remaining 43, ineligible for these trials, received supportive care. We investigated the relation between pretreatment clinical variables and long-term survival in these 89 subjects, and analyzed whether chemotherapy could favor longer survival.
  
  
  RESULTS
  There were no significant differences in survival time between the chemotherapy groups, whereas the response rate to the CEF regimen was 4-fold higher than to the FAM regimen (32 vs. 8%). Subgroup analysis suggested that chemotherapy favored longer survival in patients with a performance status (PS) of 0 or 1, but not in patients with a PS of 2. Cox regression analysis suggested a significant hazard reduction by chemotherapy in patients with a PS of 0 or 1, but not in patients with a PS of 2.
  
  
  CONCLUSIONS
  GBC patients with poor PS should not be treated with chemotherapy at present. It is essential to design good clinical trials and develop more effective chemotherapy regimens.
authors.affiliation: Division of Hepatobiliary and Pancreatic Medical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. hirishii@east.ncc.go.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishii
authors.forename: Junji
authors.initials: J
authors.lastname: Furuse
authors.forename: Naohiro
authors.initials: N
authors.lastname: Yonemoto
authors.forename: Michitaka
authors.initials: M
authors.lastname: Nagase
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshino
authors.forename: Tosiya
authors.initials: T
authors.lastname: Sato
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D004317:Doxorubicin / Q000008:administration & dosage; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D016017:Odds Ratio; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D015251:Epirubicin; D016685:Mitomycin; D004317:Doxorubicin; D002945:Cisplatin; D005472:Fluorouracil