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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.
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.
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.
Shares POLCAGB, Tata Memorial Centre, Chemoradiation (chemoradiotherapy, CRT), Neoadjuvant / adjuvant / perioperative and the tag gallbladder-evidence.
Shares BILCAP, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Neoadjuvant / adjuvant / perioperative, Capecitabine and the tag gallbladder-evidence.
Shares SWOG S0809, BILCAP, Gallbladder cancer and the tag gallbladder-evidence.
Shares Validation of the 8th Edition American Joint Commission on Cancer (AJCC) Gallbladder Cancer Staging System: Prognostic Discrimination and Identification of Key Predictive Factors, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.
Shares BILCAP, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Neoadjuvant / adjuvant / perioperative, Capecitabine and the tag gallbladder-evidence.
Shares BILCAP, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.
Shares Tata Memorial Centre, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.
Shares Tata Memorial Centre, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.