India along with countries of the Far East, Eastern Europe and Latin America have the highest incidence of gall bladder cancer in the world. Women from Delhi have an incidence of gall bladder cancer of 21.5 pere 100,000 persons, the highest in the world. Only 10-20% of the patients in developed countries have disease localized to the gall bladder at diagnosis. The number in developing countries is expected to be much smaller. Even when the disease is localized, 60% relapse within 5 years of diagnosis. About 80-90% of the patients will need chemotherapy for gall bladder cancer at presentation or at relapse. Chemotherapy is toxic and should only be used in advanced disease if it can achieve cure, prolong survival or relieve symptoms. There are large number patients of gall bladder cancer who need chemotherapy. Do they benefit from chemotherapy?
A study from India (J Clin Oncol 28:4581-4586;2010) compared chemotherapy with best supportive care (a euphemism for no active treatment used in oncology community) and showed that about 30% of the patients respond to chemotherapy. Also, chemotherapy increases the survival twofold. The focus of treatment of gall bladder cancer has been relief of biliary obstruction and symptoms. Chemotherapy will now form an important part of therapy for gall bladder cancer.