title: Outcomes of adjuvant chemoradiation and predictors of survival after extended cholecystectomy in gall bladder carcinoma: a single institution experience from an endemic region.
abstract: OBJECTIVE
  The purpose of the study was to analyse outcomes with adjuvant concurrent chemoradiotherapy (cCRT) followed by adjuvant chemotherapy (AC) in radically resected gall bladder carcinoma (GBC) in Indian patients.
  
  
  METHODS
  We retrospectively reviewed the records of GBC patients who received adjuvant cCRT after extended cholecystectomy (EC) between January 2007 and December 2011. Patterns of recurrence, disease-free survival (DFS), overall survival (OS) and adverse prognostic factors were evaluated.
  
  
  RESULTS
  Thirty-two patients were analysed. At a median follow-up of 53 months, 40 % of patients had recurrence either locoregionally (12 %) or had distant metastases (28 %). The 5-year OS and DFS was 25 % and 53 %, respectively. When prognostic factors were evaluated, the median OS was 51 versus 23 months for node-negative (n = 8) versus node-positive disease (n = 24), not reached versus 34 months for stage 2 (n = 4) versus for stage 3 (n = 28), 46 versus 23 months for R0 (n = 11) versus R1 resection (n = 21), 51 versus 12 months (p = 0.15) for well-differentiated (n = 16) versus poorly differentiated tumours (n = 8), and 10 versus 51 months for lymphovascular invasion presence (n = 4) versus absence (n = 28) (p = 0.01).
  
  
  CONCLUSIONS
  Outcome in Indian patients with cCRT followed by AC is similar to that reported in the literature. Adjuvant cCRT followed by AC improves outcomes in patients with R1 and node-positive disease. Advanced stage, nodal positivity, poor differentiation, presence of perineural invasion and lymphovascular invasion are adverse prognostic features. Further research is required with treatment intensification in patients with adverse prognostic factors to improve outcome.
authors.affiliation: Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014, India, sushmaagrawal@yahoo.co.uk.
authors.forename: S
authors.initials: S
authors.lastname: Agrawal
authors.forename: P K
authors.initials: PK
authors.lastname: Gupta
authors.forename: N
authors.initials: N
authors.lastname: Rastogi
authors.forename: A
authors.initials: A
authors.lastname: Lawrence
authors.forename: N
authors.initials: N
authors.lastname: Kumari
authors.forename: K J Maria
authors.initials: KJ
authors.lastname: Das
authors.forename: R
authors.initials: R
authors.lastname: Saxena
mesh_terms: D000328:Adult; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant; D002763:Cholecystectomy / Q000379:methods*; D018572:Disease-Free Survival; D019353:Endemic Diseases; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis