title: Neoadjuvant Chemoradiation Followed by Surgery for Locally Advanced Gallbladder Cancers: A New Paradigm.
abstract: Locally advanced (T3/T4) gallbladder cancers with large fixed portal nodes have a dismal prognosis. If undertaken, surgery entails extensive resections with high morbidity; therefore, in many centers, patients are offered palliative chemotherapy. In this prospective study, we used neoadjuvant concurrent chemoradiation with the intention of downstaging and facilitating R0 resection of these tumors.
  
  
  
  Twenty-eight patients with locally advanced carcinoma gallbladder (stage III, having deep liver infiltrations and/or large portal nodes) underwent prior positron emission tomography/computed tomography to rule out metastatic disease. All were treated with concomitant chemoradiation using helical tomotherapy (dose of 57 Gy over 25 fractions to the gross tumor and 45 Gy over 25 fractions to the surrounding nodes) with injectable gemcitabine (300 mg/m(2)/week × 5 weeks).
  
  
  
  Of the 28 patients, 25 (89 %) successfully completed planned chemoradiation and 20 (71 %) achieved partial or complete radiologic response. Eighteen (64 %) patients were surgically explored, of whom 14 (56 %) achieved R0 resection. At the median follow-up of 37 months for the surviving patients, the median overall survival (OS) was 20 months for all patients. Only one patient recurred in the common bile duct postsurgery, whereas six patients had distant metastasis. The 5-year OS was 24 % for all patients and 47 % for patients with R0 resection. Biliary leak was seen in 6 (43 %) patients, of whom two required interventions.
  
  
  
  Locally advanced unresectable cancers may benefit from neoadjuvant chemoradiation to facilitate a curative resection with a good survival.
authors.affiliation: Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India. reena.engineer@gmail.com.
authors.forename: Reena
authors.initials: R
authors.lastname: Engineer
authors.affiliation: Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Goel
authors.affiliation: Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Supriya
authors.initials: S
authors.lastname: Chopra
authors.affiliation: Department of Medical Gastroenterology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Prachi
authors.initials: P
authors.lastname: Patil
authors.affiliation: Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, India.
authors.forename: Nilendu
authors.initials: N
authors.lastname: Purandare
authors.affiliation: Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, India.
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Rangarajan
authors.affiliation: Department of Medical Physics, Tata Memorial Hospital, Mumbai, India.
authors.forename: Reena
authors.initials: R
authors.lastname: Ph
authors.affiliation: Department of Surgical Pathology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Munita
authors.initials: M
authors.lastname: Bal
authors.affiliation: Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Shailesh
authors.initials: S
authors.lastname: Shrikhande
authors.affiliation: Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
authors.forename: S K
authors.initials: SK
authors.lastname: Shrivastava
authors.affiliation: Department of Medical Gastroenterology, Tata Memorial Hospital, Mumbai, India.
authors.forename: S
authors.initials: S
authors.lastname: Mehta
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D059248:Chemoradiotherapy; D005260:Female; D005706:Gallbladder Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome