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Benefit of adjuvant radiotherapy for gallbladder cancer: a comparability-based meta-analysis

 Seo Hee Choi  ;  Chai Hong Rim  ;  In-Soo Shin  ;  Won Sup Yoon  ;  Woong Sub Koom  ;  Jinsil Seong 
 HEPATOLOGY INTERNATIONAL, Vol.16(3) : 712-727, 2022-06 
Journal Title
Issue Date
Gallbladder Neoplasms* / pathology ; Gallbladder Neoplasms* / radiotherapy ; Humans ; Neoplasm Recurrence, Local ; Radiotherapy, Adjuvant / methods
Adjuvant ; Gallbladder neoplasm ; Radiotherapy ; Survival
Background and purpose: The benefits of adjuvant radiotherapy (ART) in gallbladder cancer (GBC) treatment remain inconclusive owing to the rarity of GBC and lack of randomized studies.

Methods: PubMed, Medline, Embase, and Cochrane Library were systematically searched until March 2021. The primary endpoint was overall survival (OS). Comparative clinical studies that reported survival outcomes in GBC patients treated with or without ART were included. The comparability of each study was assessed by considering all possible clinical indicators (group 2: ART arm with poor clinical profile; group 1: ART arm with statistically similar profile or no evidence of having inferior clinical factors compared to non-ART arm).

Results: Twenty-one studies involving 6876 GBC patients were reviewed. In pooled analyses of OS, the odds ratio (OR) was 1.26 (p = 0.111) neither favoring ART or non-ART arms. In subgroup analyses considering comparability, the OR significantly favored the ART arm (1.92, p = 0.008) among comparability group 1 studies, whereas it was 1.03 (p = 0.865) in comparability group 2 studies. The pooled rate of 5-year OS in the ART vs. non-ART arms was 44.9% vs. 20.9% in group 1 and 34.1% vs. 40.0% in group 2. With ART, significant reduction in locoregional recurrence (OR 0.21, p = 0.001) but not in distant metastasis (OR 1.32, p = 0.332) was noted.

Conclusion: ART not only showed benefits in patients with a similar clinical profile to those treated without ART but also yielded comparable survival in patients with an inferior clinical profile. Our results suggest the more active application of ART in GBC treatment.

Protocol registration: This study is registered in PROSPERO (CRD42021240624, available at: https://www.crd.york.ac.uk/ ).
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Koom, Woong Sub(금웅섭) ORCID logo https://orcid.org/0000-0002-9435-7750
Seong, Jin Sil(성진실) ORCID logo https://orcid.org/0000-0003-1794-5951
Choi, Seo Hee(최서희) ORCID logo https://orcid.org/0000-0002-4083-6414
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