A randomised trial of adjuvant chemoradiation after margin-positive or node-positive gallbladder cancer resection
Radiotherapy after gallbladder cancer surgery rests on one 79-patient trial with no comparison arm and a US insurance database. People whose surgery left cancer at the edge or in the nodes are the ones it might help, and they have never been randomised.
Overview
SWOG S0809 gave chemotherapy then chemoradiation to 79 patients after resection with pT2 to 4, node-positive or margin-positive disease: two-year survival was 65 percent and no worse after R1 (60 percent) than R0 (67 percent) resection. Wang's SEER-Medicare nomogram (1,137 patients) predicts benefit for T2 or N1 or worse, and the NCDB validation found radiotherapy associated with lower mortality in T2 to T4 disease. NCCN lists chemoradiation as an option; the UK does not routinely offer it. POLCAGB tests radiotherapy before surgery in locally advanced disease, but the adjuvant R1 or node-positive question, where local recurrence is a real fraction of failures (14 local, 9 combined of 47 relapses in S0809), has no randomised trial.
- Surgery and radiotherapy cure most, get least · Surgery and radiotherapy cure more people than drugs do, but attract a fraction of the research investment.
- Trials enrol too few, too slowly · Fewer than one in ten adults with cancer joins a trial. Trials close for lack of patients, not lack of ideas.
Anatomy alone explains only about two thirds of the ranking of who lives longer; the 2026 staging review makes the same point and argues for molecular and nodal-burden modifiers alongside TNM.
This single-arm trial is why NCCN lists chemoradiation after a positive margin or involved nodes. The near-identical survival after R0 and R1 resection is suggestive but unproven; no randomised trial has followed, and the UK does not routinely offer it.
The observational basis, with SWOG S0809, for offering chemoradiation after node-positive or margin-positive resection in the United States. UK practice rarely does so; a randomised trial has never been run.
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