The Role of Radiotherapy for Carcinomas of the Gall Bladder and Extrahepatic Biliary Duct: Retrospective analysis

Jeong, Hyeon Ju; Lee, Hyun Ju; Yang, Kwang Mo; Suh, Hyun Suk; Kim, Re Hwe; Kim, Sung Rok; Kim, Hong Ryong

Abstract

PURPOSE: Carcinomas arising in the gall bladder (GB) or extrahepatic biliary ducts are uncommon and generally have a poor prognosis. The overall 5- year survival rates are less than 10%. Early experiences with the external radiation therapy demonstrated a good palliation with occasional long-term survival. The present report describes our experience over the past decade with irradiation of primary carcinomas of the gallbladder and extrahepatic biliary duct.
MATERIALS AND METHODS
From Feb. 1984 to Nov. 1995, thirty-three patients with carcinoma of the GB and extrahepatic biliary duct were treated with external beam radiotherapy with curative intent at our institution. All patients were treated with 4-MV linear accelerator and radiation dose ranged from 31.44Gy to 54.87Gy (median 44.25Gy), and three patients received additional intraluminal brachytherapy (range, 25Gy to 30Gy). Twenty-seven patients received a postoperative radiation. Among 27 patients, Sixteen patients underwent radical operation with curative aim and the rest of the patients either had bypass surgery or biopsy alone. In seventeen patients, adjuvant chemotherapy was used and eleven patients were treated with 5-FU, mitomycin and leucovorin.
RESULTS
Median follow up period was 8.5 months (range 2-97 months). The overall 2-year and 5-year survival rates in all patients were 29.9% and 13.3% respectively. In patients with GB and extrahepatic biliary duct carcinomas, the 2-year survival rates were 34.5% and 27.8% respectively. Patients who underwent radical operation showed better 2-year survival rates than those who underwent palliative operation (43.8% vs. 20.7%). albeit, statistically insignificant (P>0.05). The 2-year survival rates in Stage I and II were higher than in Stage III and IV with statistical significance (P<0.05). Patients with good performance status in the beginning showed significantly better survival rates than those with worse status (P<0.05). The 2-year survival rates in combined chemotherapy group and radiation group were 40.5% and 22.6% respectively. There was no statistical differences in two groups (P>0.05).
CONCLUSION
The survival of patients with relatively lower stage and/or initial good performance was significantly superior to that of others. We found an statistically insignificant trend toward better survival in patients with radical operation and/or chemotherapy. More radical treatment strategies, such as total resection with intensive radiation and/or chemotherapy may offer a better chance for cure in selective patients with carcinoma of gall bladder and extrahepatic biliary ducts.