Treatment

The clinical course of gallbladder cancer is often so indolent that at the time of presentation there has been local invasion, lymph node metastases, and distant metastases, for example to the lungs or bone.

Early tumours may be treated successfully by cholecystectomy in conjunction with wedge resection of the liver bed plus regional lymphadenectomy. Surgery may also be of value for small invasive tumours. The goal of surgery is to achieve negative margins (there is a 20% to 43% 5-year survival rate if this occurs) (1)

NCCN recommends treatment with durvalumab, in combination with gemcitabine and cisplatin, in patients who develop recurrent disease more than 6 months after surgery with curative intent and more than 6 months after completion of adjuvant therapy. (2)

In more advanced diseases, radiotherapy and cytotoxic chemotherapy have no significant effect. Palliative treatment, for example analgesics and sedatives, are the only course available.

The best prognosis is often from those tumours found as an incidental finding at cholecystectomy. The response rate to chemotherapy alone is <15% (3)

Reference

1. Nakagohri T, Asano T, Kinoshita H, et al. Aggressive surgical resection for hilar-invasive and peripheral intrahepatic cholangiocarcinoma. World J Surg. 2003;27:289-293.
2. Oh DY, Aiwu RH, Qin S, et al. ​Durvalumab plus gemcitabine and cisplatin in advanced biliary tract cancer. NEJM Evid 2022 Jun 1;1(8).
3. Furuse J, Okusaka T, Funakoshi A, et al. Early phase II study of uracil-tegafur plus doxorubicin in patients with unresectable advanced biliary tract cancer. Jpn J Clin Oncol. 2006;36:552-556.