[A case of unresectable advanced gallbladder cancer successfully treated by a combined administration of gemcitabine + CDDP].

The patient, a 54-year-old male, reported to our hospital with major complaints of epigastric pain and brownish coloration of the urine. His history included resections of the left kidney and ureter due to a cancer of the left renal pelvis. The diagnosis was gallbladder cancer with infiltration of the liver and mesoduodenal ligament and lymphatic metastasis. Surgery was conducted after jaundice had ameliorated. But his condition was judged not to be amenable to surgery: the procedure was limited to an exploratory laparotomy. Chemotherapy composed of gemcitabine 1,000 mg/m2 + CDDP 25 mg/m2 (administered for 2 weeks followed by one week of no treatment, repeated for 8 cycles) was initiated on the 16th day of illness. In a phase III trial (the UK ABC-02 trial) conducted by the American Society of Clinical Oncology (ASCO) in 2009, in which gemcitabine + CDDP combination therapy was compared against gemcitabine monotherapy to treat patients with advanced or metastatic biliary tract cancers, the overall duration of survival was significantly prolonged and the mortality risk reduced. Therefore, the result of this trial was used as a reference for the current study. After one cycle applied while the patient was in the hospital, no adverse effects of the chemotherapy were found and a subsequent treatment was given on an outpatient basis. No adverse effects attributable to the chemotherapy were noted until 8 cycles were completed. The tumor marker levels were much reduced. The tumor was reduced in size and marked improvement was noted in bile duct stenosis. With a careful observation of the clinical course, the procedure for unresectable gallbladder cancer shown here may be applied on an outpatient basis. It is an effective and safe therapeutic modality, which may become a standard therapeutic procedure.