Multimodality management of gallbladder cancer can lead to a better outcome:Experience from a tertiary care oncology centre in North India

BACKGROUND Surgical resection is a treatment of choice for gallbladder cancer(GBC)patients but only 10%of patients have a resectable disease at presentation.Even after surgical resection,overall survival(OS)has been poor due to high rates of recurrence.Combination of surgery and systemic therapy can improve outcomes in this aggressive disease.AIM To summarize our single-center experience with multimodality management of resectable GBC patients.METHODS Data of all patients undergoing surgery for suspected GBC from January 2012 to December 2018 was retrieved from a prospectively maintained electronic database.Information extracted included demographics,operative and perioperative details,histopathology,neoadjuvant/adjuvant therapy,follow-up,and recurrence.To know the factors associated with recurrence and OS,univariate and multivariate analysis was done using log rank test and cox proportional hazard analysis for categorical and continuous variables,respectively.Multivariate analysis was done using multiple regression analysis.RESULTS Of 274 patients with GBC taken up for surgical resection,172(62.7%)were female and the median age was 56 years.On exploration,102 patients were found to have a metastatic or unresectable disease(distant metastasis in 66 and locally unresectable in 34).Of 172 patients who finally underwent surgery,93(54%)underwent wedge resection followed by anatomical segment IVb/V resection in 66(38.4%)and modified extended right hepatectomy in 12(7%)patients.The postoperative mortality at 90 d was 4.6%.During a median follow-up period of 20 mo,71(41.2%)patients developed recurrence.Estimated 1-,3-,and 5-years OS rates were 86.5%,56%,and 43.5%,respectively.Estimated 1-and 3-year disease free survival(DFS)rates were 75%and 49.2%,respectively.On multivariate analysis,inferior OS was seen with pT3/T4 tumor(P=0.0001),perineural invasion(P=0.0096),and R+resection(P=0.0125).However,only pT3/T4 tumors were associated with a poor DFS(P<0.0001).CONCLUSION Multimodality treatment significantly improves the 5-year survival rate of patients with GBC up to 43%.R+resection,higher T stage,and perineural invasion adversely affect the outcome and should be considered for systemic therapy in addition to surgery to optimize the outcomes.Multimodality treatment of GBC has potential to improve the survival of GBC patients.

Gallbladder cancer with tumor thrombus in the superior vena cava

BACKGROUND:Gastrointestinal cancers,especially pancreatobiliary cancers,are frequently associated with or are complicated by thromboembolic phenomena due to hypercoagulability and/or altered venous drainage,especially of the abdomen and lower limbs.This report describes an unusual and interesting case of gallbladder carcinoma developing a viable tumor thrombus in the superior vena cava(SVC)with resultant SVC obstruction,while on gefitinibbased anti-epidermal growth factor receptor(EGFR)therapy.METHODS:A 60-year-old woman was incidentally diagnosed to have gallbladder cancer on cholecystectomy.She had disease recurrence and received systemic chemotherapy followed by gefitinib-based anti-EGFR therapy.Subsequently,while on gefitinib-based therapy,she presented with clinical signs and symptoms suggestive of SVC thrombosis.RESULTS:A whole body PET scan revealed a metabolically active tumor thrombus in the SVC,besides other sites of metabolically active disease inclusive of the lung parenchyma, lymph nodes and abdomen.She was treated with antithrombotics and external beam radiotherapy directed to the SVC thrombus leading to symptomatic relief.She continues to survive on the day of writing this report.CONCLUSIONS:This rare complication,though theoretically possible,is unreported because of the short overall survival of advanced gallbladder cancer patients.This highlights that with the availability of better chemotherapeutic/biotherapeutic agents for increasing in the lifespan of cancer patients,we may come across such cases more frequently in the future.

Co-relation of SARS-CoV-2 related 30-d mortality with HRCT score and RT-PCR Ct value-based viral load in patients with solid malignancy

BACKGROUND Coronavirus disease 2019(COVID-19)patients with malignancy are published worldwide but are lacking in data from India.AIM To characterize COVID-19 related mortality outcomes within 30 d of diagnosis with HRCT score and RT-PCR Ct value-based viral load in various solid malignancies.METHODS Patients included in this study were with an active or previous malignancy and with confirmed severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection from the institute database.We collected data on demographic details,baseline clinical conditions,medications,cancer diagnosis,treatment and the COVID-19 disease course.The primary endpoint was the association between the mortality outcome and the potential prognostic variables,specially,HRCT score,RT-PCR Ct value-based viral load,etc.using logistic regression analyses treatment received in 30 d.RESULTS Out of 131 patients,123 met inclusion criteria for our analysis.The median age was 57 years(interquartile range=19-82)while 7(5.7%)were aged 75 years or older.The most prevalent malignancies were of GUT origin 49(39.8%),hepatopancreatobiliary(HPB)40(32.5%).109(88.6%)patients were on active anticancer treatment,115(93.5%)had active(measurable)cancer.At analysis on May 20,2021,26(21.1%)patients had died.In logistic regression analysis,independent factors associated with an increased 30-d mortality were in patients with the symptomatic presentation.Chemotherapy in the last 4 wk,number of comorbidities(≥2 vs none:3.43,1.08-8.56).The univariate analysis showed that the risk of death was significantly associated with the HRCT score:for moderate(8-15)[odds ratio(OR):3.44;95%confidence interval(CI):1.3-9.12;P=0.0132],severe(>15)(OR:7.44;95%CI:1.58-35.1;P=0.0112).CONCLUSION To the best of our knowledge,this is the first study from India reporting the association of HRCT score and RT-PCR Ct value-based 30-d mortality outcomes in SARS-CoV-2 infected cancer patients.

Malignant ascites with omental metastasis: a rare event in prostate cancer

Prostate cancer is the most common type of male malignancy in the world and approximately 10-20%of prostate cancer shows a metastatic disease at initial diagnosis commonly to the bones,vertebrae,ribs,long bones,and skull.However,prostate cancer metastasis to the omentum with malignant ascites is extremely uncommon.In this study,we report such a case,which also highlights a repeatedly negative ascetic fluid cytology even with multiple omental metastatic nodules.The purpose of this case report is to provide awareness to physicians for this rare occurrence.