Nonsurgical Management of Gallbladder Cancer

Abstract

Gallbladder cancer is an uncommonmalignancy and historically thought to have a poor prognosis. Nevertheless, interdisciplinary approaches to care and the advent of precision medicine have improved overall survival outcomes. Most agree that for patients with at least Stage IB disease, adjuvant chemotherapy and chemoradiation therapy improve overall survival. There are no standard guidelines for adjuvant radiation, but many agree to perform adjuvant radiation for R1 disease. Modern chemotherapy protocols have improved response rates for locally advanced disease; yet no clear guidelines for neoadjuvant therapy have been established. External beam, stereotactic radiation, and brachytherapy can provide local palliation and improve hyperbilirubinemia. Gemcitabine- and 5-FU-based chemotherapy combinations have long demonstrated activity in this disease; however, targeted therapy approaches including immunotherapy will serve as new treatment modalities in the future.