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.

Bone metastases from primary hepatocellular carcinoma simulating multiple myeloma

A 65-year-old man presented with bone pains and anemia. Skull X-ray revealed multiple osteolytic lesions. The pa- tient was evaluated for multiple myeloma but detailed workup revealed the diagnosis of primary hepatocellular carcinoma (HCC) with osteolytic bone metastases. Thus, bone metastases due to HCC, although rare, should be considered in patients presenting with bone pains due to os- teolytic lesions.

Synthesis and Development of Gd³⁺-ALGDG₂-C595 as MR Imaging Contrast Agent

Magnetic Resonance imaging (MR imaging) as a powerful non-invasive modality is of high global interest for early cancer detection. The aim of this study was the synthesis of nanodendrimer and its conjugate with monoclonal antibody C595 against breast cancer cell, followed by its chelating with gadolinium for its magnetic property. First, anti-MUC-1 monoclonal antibody C595 was coupled to a biodegradable biocompatible Anionic Linear Globular Dendrimer G2 (having polyethylene glycol core and citric acid shell). Then prepared nanocomplex loaded by gadolinium to make novel agent of functional MR imaging. Anticancer effects and MR imaging parameters of the prepared nanoconjugate was investigated under in vitro conditions doing performing several studies such as evaluation of monoclonal antibody C595 binding to mucine-1 (MUC-1) cell, its purification, size of nanoconjugate and relaxivity measurements. The obtained data showed a powerful relaxations as well as selective MUC-1 antigen binding to the cell. Based on the findings from the present research Gd3+-ALGDG2-C595 nano-probe may be a potential breast molecular imaging and therapeutic agent. However, further investigations by in vivo studies and clinical trials are in the pipeline.