406 Background: Surgery is the treatment of choice for patients with carcinoma gall bladder patients (GBC). However, most of the patients are metastatic at the time of diagnosis with only a fraction of patients deemed non metastatic. Many are locally advanced either infilterating liver, orinvolving adjacent other organs. Studies with gemcitabine for metastatic biliary tract cancers have shown promising results. Extrapolating these results to locally advanced GBC might improve the outcomes in these otherwise poor risk patients. Methods: Patients with locally advanced GBC from January 2013 to June 2014 who were considered borderline resectable on cross sectional imaging were planned for preoperative gemcitabine based chemotherapy to downsize the tumor and make them resectable. Gemcitabine and cisplatin based chemotherapy was given to all these patients and evaluated after 3 cycles. Those who became resectable were taken up for surgery and rest were given additional three cycles of chemotherapy. Results: 840 patients of GBC were seen in the out patient department since January 2013. Of these, 40 patients with locally advanced GBC were considered for neoadjuvant chemotherapy (Gemcitabine and cisplatin). However, only 22 patients actually received neoadjuvant chemotherapy. Out of these 22 patients, 4 are still receiving chemotherapy. Of 18 patients who completed there chemotherapy schedule, 2 patients lost to follow up after receiving 3 cycles of chemotherapy. 15 patients (83.3%%) had good radiological response to chemotherapy and were advised surgery. One patient had no radiological response. 3 patients refused surgery inspite of good radiological response. 13 patients (including the patient who did not have radiological response) underwent surgery. Out of 13 patients, 4 patients had metastatic disease intraoperatively. 9 out of 16 patients (56.25%) underwent R0 resection. Conclusions: Best surgical outcomes are seen with those undergoing RO resection. Neoadjuvant chemotherapy can downsize the tumor in approximately 50% of the patients leading to R0 resection. Neoadjuvant chemotherapy should be considered in locally advanced GBC with the aim of increasing the resectablility in these patients.
Neoadjuvant Chemotherapy in Locally Advanced Unresectable Carcinoma Gall Bladder (ENACT Trial): A Novel Beginning in a Tertiary Centre in North India
