tailieunhanh - Diseases of the Gallbladder and Bile Ducts - part 7

Các bệnh nhân với một cắt bỏ (R0) margin-tiêu cực tiếp theo là tá dược EBRT cộng với 5-FU đã một tỷ lệ sống 5 năm thuận lợi của 64%. Tuy nhiên, tương tự như những phát hiện của Jarnagin et al. [58], 67% bệnh nhân bị suy xa, nhấn mạnh sự cần thiết phải điều trị hoá chất | 258 Section 3 Specific conditions 1997. Patients with a margin-negative R0 resection followed by adjuvant EBRT plus 5-FU had a favorable 5-year survival rate of 64 . However similar to the findings of Jarnagin et al. 58 67 of the patients suffered distant failure emphasizing the need for more effective adjuvant chemotherapy for this disease. Intraoperative radiation therapy IORT has been advocated as a means to deliver high-dose small-field therapy di-rectlytothetumorbedwithoutthedoselimitationsassociated with EBRT. Todoroki et al. 66 have reported the most substantial experience with IORT in 85 patients with AJCC stage IV gallbladder cancer who underwent aggressive surgical resection with or without IORT at a mean dose of 21 Gy. Fortyseven patients in total receivedsome form ofradiation therapy EBRT and or IORT . The local control rate was significantly higher after adjuvant radiotherapy 59 than after resection alone 36 . Moreover the 5 -year survival rate was significantly higher after adjuvant radiotherapy 9 than after resection alone 3 with the most pronounced improvement in 5-year survival rate 17 in patients with only microscopic residual disease R1 resection . T he role of radiation therapy for the palliation of symptoms such as jaundice pain and pruritus in patients with unresectable disease is difficult to ascertain as published studies consist of small numbers of patients with the significant confounding variable that most patients also underwent a biliary drainage procedure 59 67 68 . Chemotherapy Most published studies concerning the role of chemotherapy in patients with locally advanced or metastatic gallbladder carcinoma are limited by the small numbers of patients and by the inclusion of patients with biliary tract cancers. Unfortunately no single chemotherapeutic agent or combination of agents has been identified to be effective in the treatment of this disease Table . Though overall response rates range as high as 64 complete responses are .