Gallbladder cancer medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]
Overview
Gallbladder cancer (GBC) is a rare but highly fatal malignancy. The therapy for gallbladder cancer depends largely on the disease progression and the stage of cancer at the time of diagnosis.
Medical Therapy
There are different types of treatment for patients with gallbladder cancer.
- The only important curative modality for patients with GBC is surgery
MEDICAL THERAPY FOR OBSTRUCTIVE JAUNDICE[1][2]
- In 30 to 60 percent of patients with GBC biliary obstruction is the main cause for Jaundice
- Direct infiltration of the common hepatic duct by tumor is the acutall cause
- maximum patients who present with jaundice are normally no longer amenable to a healing resection.
- Biliary or intestinal bypass are considered one of the therapy for palliation of obstructive jaundice
- To relive palliate jaundice and pruritus as little as 30 percent of the liver parenchyma drainage by using stents should be neccesary.
- And stents are placed by using endoscope
- Percutaneous self-expanding metal stent placing is an alternative to endosscopically placed stents
- If patients are symptomatic consider external beam radiation therapy (EBRT) for palliative management
- A combination of chemotherapy and RT is considered in locally advanced unresectable disease
- The first site of failure is usally locoregional whn using with or without chemotherapy
- For locally advanced unresectable GBC chemoradiotherapy is an acceptable despite uncertainty about the benefits[5]
- For patients with locally advanced, unresectable GBC, National Comprehensive Cancer Network (NCCN) suggests chemotherapy based on fluoropyrimidine or palliative chemotherapy
SYSTEMIC CHEMOTHERAPY
- In the treatment of advanced GBC systemic chemotherapy provides little benefit
- A range of 10 to 60 % response rate is observed with chemotherapy
- Drugs that used in chemotherapy are[6]
- Fluorouracil
- Leucovorin
- Gemcitabine plus oxaliplatin
FU-based therapy
- The median survival was usally less than six months when FU alone or FU-based combination therapies used.[7]
References
- ↑ Kapoor VK, Pradeep R, Haribhakti SP, Singh V, Sikora SS, Saxena R, Kaushik SP (1996). "Intrahepatic segment III cholangiojejunostomy in advanced carcinoma of the gallbladder". Br J Surg. 83 (12): 1709–11. PMID 9038546.
- ↑ Piñol V, Castells A, Bordas JM, Real MI, Llach J, Montañà X, Feu F, Navarro S (2002). "Percutaneous self-expanding metal stents versus endoscopic polyethylene endoprostheses for treating malignant biliary obstruction: randomized clinical trial". Radiology. 225 (1): 27–34. doi:10.1148/radiol.2243011517. PMID 12354980.
- ↑ Ben-David MA, Griffith KA, Abu-Isa E, Lawrence TS, Knol J, Zalupski M, Ben-Josef E (2006). "External-beam radiotherapy for localized extrahepatic cholangiocarcinoma". Int. J. Radiat. Oncol. Biol. Phys. 66 (3): 772–9. doi:10.1016/j.ijrobp.2006.05.061. PMID 17011452.
- ↑ Jarnagin WR, Ruo L, Little SA, Klimstra D, D'Angelica M, DeMatteo RP, Wagman R, Blumgart LH, Fong Y (2003). "Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma: implications for adjuvant therapeutic strategies". Cancer. 98 (8): 1689–700. doi:10.1002/cncr.11699. PMID 14534886.
- ↑ Engineer R, Goel M, Chopra S, Patil P, Purandare N, Rangarajan V, Ph R, Bal M, Shrikhande S, Shrivastava SK, Mehta S (2016). "Neoadjuvant Chemoradiation Followed by Surgery for Locally Advanced Gallbladder Cancers: A New Paradigm". Ann. Surg. Oncol. 23 (9): 3009–15. doi:10.1245/s10434-016-5197-0. PMID 27075323.
- ↑ Patt YZ, Hassan MM, Lozano RD, Waugh KA, Hoque AM, Frome AI, Lahoti S, Ellis L, Vauthey JN, Curley SA, Schnirer II, Raijman I (2001). "Phase II trial of cisplatin, interferon alpha-2b, doxorubicin, and 5-fluorouracil for biliary tract cancer". Clin. Cancer Res. 7 (11): 3375–80. PMID 11705850.
- ↑ Patt YZ, Hassan MM, Lozano RD, Waugh KA, Hoque AM, Frome AI, Lahoti S, Ellis L, Vauthey JN, Curley SA, Schnirer II, Raijman I (2001). "Phase II trial of cisplatin, interferon alpha-2b, doxorubicin, and 5-fluorouracil for biliary tract cancer". Clin. Cancer Res. 7 (11): 3375–80. PMID 11705850.