This study sought to identify potential candidates for adjuvant radiotherapy and patterns of regional failure in patients who underwent curative-intent surgery for gallbladder cancer. Records for 70 patients with gallbladder cancer who underwent curative resection at a single institution between 2000 and 2016 were analysed retrospectively. No patients received adjuvant radiotherapy. Initial patterns of failure were evaluated. Regional recurrence was categorized according to the definitions of lymph node stations suggested by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. Median follow-up was 23 months. Locoregional recurrence as any component of first failure occurred in 29 patients (41.4%), with isolated locoregional recurrence in 13 (18.6%). Regional recurrence occurred in 23 patients, and 77 regional recurrences were identified. Commonly involved regional stations were #13, #12a2, #12p2, #12b2, #16a2, #16b1, #9, and #8. Independent prognostic factors for locoregional recurrence were ≥pT2 disease (hazard ratio [HR], 5.510; 95% confidence interval [CI], 1.260-24.094; p = 0.023) and R1 resection (HR, 6.981; 95% CI, 2.378-20.491; p < 0.001). Patients with pT2 disease or R1 resection after curative surgery for gallbladder cancer may benefit from adjuvant radiotherapy. Our findings on regional recurrence may help physicians construct a target volume for adjuvant radiotherapy.

Lee E, et al. Radiat Oncol J. 2015 Sep;33(3):217-225. http://dx.doi.org/10.3857/roj.2015.33.3.217

Kim TG, et al. J Korean Med Sci. 2013 Aug;28(8):1233-1237. http://dx.doi.org/10.3346/jkms.2013.28.8.1233

The authors would report the results of definitive radiation therapy (RT) for early glottic cancer by two different radiation dose schedules. From February of 1995 till June of 2008, 157 patients with T1-2N0 glottic cancer were treated with curative RT at Samsung Medical Center. All patients had squamous cell carcinoma, and there were 89 patients (56.7%) with T1a, 36 (22.9%) with T1b, and 32 (20.4%) with T2. Two different radiation dose schedules were used: 70 Gy in 35 fractions to 64 patients (40.8%, group A); and 67.5 Gy in 30 fractions to 93 patients (59.2%, group B). The median treatment durations were 50 days (range, 44 to 59 days) and 44 days (range, 40 to 67 days) in the groups A and B, respectively. The median follow-up durations were 85 and 45 months for the groups A and B. No severe late complication of RTOG grade 3 or higher was observed, and there was no difference in acute or chronic complication between the groups. Twenty-four patients experienced treatment failure: local recurrence only in 19 patients; regional recurrence only in one; combined local and regional recurrence in four; and systemic metastasis in none. The overall 5-year disease-free survival and disease-specific survival rates were 84.7% and 94.8%. The disease-free survival rate in the group B was better (78.3% vs. 90.8%, P=0.031). This difference was significant only in T1 stage (83.4% vs. 94.6%, P=0.025), but not in T2 (62.7% vs. 60.6%, P=0.965). Univariate analysis showed that the tumor extent, cord mobility, T-stage, and the dose schedule had significant influence on the disease-free survival, and multivariate analysis showed that only the tumor extent and the dose schedule were associated with the disease-free survival. Superior disease-free survival could be achieved by 2.25 Gy per fraction without increased toxicity over shorter RT duration, when compared with 2.0 Gy per fraction.

The role of adjuvant radiotherapy (RT) and setting proper RT target volumes have not been clearly demonstrated for extrahepatic bile duct (EHBD) cancer, due to the rarity of the disease and the lack of randomized trials. This study was conducted to evaluate the indication and treatment volume for adjuvant RT in EHBD cancer patients by identifying the prognostic factors for loco-regional (LR) failure, and analyze the patterns of LR failure. Ninety-three patients with EHBD cancer, who underwent resection without adjuvant RT, at 2 medical centers, between 2001 and 2016, were analyzed retrospectively. Univariable and multivariable analyses were performed to find the prognostic factors for LR recurrence. The initial patterns of failure were recorded, especially those of LR recurrence, and categorized according to the Japanese classification. The median follow-up duration was 30 months, and 38 (40.9%) patients experienced LR recurrence during this period. With regards to LR recurrence, close or positive resection margin (RM) status (p < 0.001) remained statistically significant in the multivariable analysis. The most common LR recurrence sites were the tumor bed (18.3%), and lymph node (LN) stations No. 8 (14.1%), No. 9 (12.7%), No. 12 (12.7%), No. 13 (5.6%), No. 14 (21.1%), No. 16 (14.1%), and No. 17 (1.4%). A close or positive RM status may be suggestive of high LR recurrence rates. In such cases, adjuvant RT may improve outcomes. When adjuvant RT is performed, the treatment volume should be well-designed so as to encompass the tumor bed, as well as LN stations No. 8, No. 9, No. 12, No. 14, and No. 16.