LWBK1006-20 LWW-Govindan-Review December 12, 2011 19:4
Chapter 20•Cancer of the Gastrointestinal Tract 259from 0% to 21%. The risk of resection for each patient and each type of
resection needs to be weighed against the chance of benefiting from the
procedure on the basis of the tumor stage.Answer 20.3.11. The answer is A.
Balachandran et al. reported on 117 patients with gallbladder cancer, of
whom 80 underwent simple cholecystectomy and 37 underwent extended
resections. Seventy-three patients received adjuvant chemoradiotherapy
and 44 patients did not. The median survival of all 117 patients was
16 months. On multivariate analysis, the T stage and use of adjuvant
therapy were the only statistically significant independent predictors of
survival. Median survival was 24 months and 11 months in patients with
or without adjuvant chemoradiotherapy (p=.001), respectively, and this
difference was most pronounced for patients with T3, node-positive dis-
ease, or after a simple cholecystectomy. Ben-David et al. reported on
14 patients with gallbladder cancer treated at the University of Michi-
gan with resection followed by radiotherapy or chemoradiotherapy. The
median radiation dose was 54 Gy, and approximately half the patients
received concurrent chemotherapy. The median survival was 23 months.
Interestingly, there was no difference in survival between patients with
R0 or R1 resection. No differences were observed in survival or pattern
of failure between patients with gallbladder cancer and bile duct cancer
(distal or hilar). The high risk of systemic spread and locoregional failure
associated with gallbladder cancer that extends beyond the mucosa has
led most cancer centers in the United States to recommend consideration
of adjuvant chemotherapy and radiotherapy. For external beam radia-
tion therapy, the target volume should include the gallbladder fossa and
adjacent liver, as well as the regional nodal areas.Answer 20.3.12. The answer is C.
Fibrolamellar HCC is a rare histologic variant of HCC. Most patients
present in the third decade of life, and it affects men and women equally.
This variant of HCC is uncommonly associated with prior cirrhosis or
viral hepatitis. In addition, a higher proportion of patients with fibro-
lamellar HCC have lymph node metastases at presentation, than the usual
HCC.Answer 20.3.13. The answer is B.
This man has a hepatic mass within a cirrhotic liver, which is very suspi-
cious for HCC. The radiologic features are also highly suggestive of HCC.
If the mass is more than 2 cm in size with characteristic appearance of
HCC on imaging, and AFP is more than 200ng/ml, biopsy is not essential
for management. Patients with a high clinical suspicion for HCC who
are deemed appropriate surgical candidates should be taken to surgery
without a preoperative biopsy.Answer 20.3.14. The answer is C.
Hepatoblastoma is the most common primary cancer of the liver in chil-
dren. The peak incidence is within the first 2 years of life. Surgical resection