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Gallbladder cancer is a rare but highly morbid condition that accounts for most (over 70%) biliary tract cancers, with a 5-year survival rate of just 17.6% from 2007 to 2013.[1][2][3] The poor prognosis of gallbladder cancer is attributed to its late presentation, complex surrounding anatomy, advanced stage at diagnosis, and the aggressive nature of the tumor.[4] Gallbladder cancer is particularly challenging to treat when inoperable. However, recent advancements in radiotherapy, including brachytherapy, offer a promising therapeutic alternative. This activity explores the application of brachytherapy when managing gallbladder cancer, detailing its techniques, indications, contraindications, and the role of the interprofessional healthcare team in optimizing patient outcomes. Gallbladder cancer occurs in around 1 in 500,00 people, and women develop this cancer anywhere from 2 to 3 times more frequently than men. Gallbladder cancer is the fifth most common cancer in the gastrointestinal tract, and it affects the gallbladder and surrounding biliary tract structures. Gallbladder cancer accounts for 80% to 90% of all biliary tract cancers, followed by cholangiocarcinoma.[5] Gallbladder cancer progression typically follows a sequence from metaplasia to dysplasia to carcinoma, with chronic inflammation serving as the most significant risk factor. This disease is postulated to be most prevalent in women due to hormonal variations influencing bile cholesterol levels, which can lead to gallstone formation and the consequent inflammatory cascade.[6] Cholelithiasis occurs in around 85% of people with gallbladder cancer. The tumor is believed to arise from chronic irritation from gallstones, beginning as epithelial dysplasia and transforming later into carcinoma. Genetic makeup also plays a role, as changes in tumor suppressor genes (TP53) and protooncogenes (Kras and c-erbB-2) also increase the odds of developing gallbladder cancer.[7] More than 90% of gallbladder cancer cases belong to the adenocarcinoma subset; histologic subtypes include papillary, mucinous, squamous, and adenosquamous carcinoma. Differentiation commonly follows biliary, intestinal, or gastric foveolar patterns. Approximately 60% of cases involve the gallbladder fundus, 30% occur in the body, and 10% are in the neck.

Brachytherapy for gallbladder cancer carries certain risks due to its invasive nature. Acute adverse events include nausea and elevated transaminase levels, which are generally mild. However, severe complications can arise, such as cholangitis, gastrointestinal and biliary bleeding, and duodenal stenosis. Dose constraints ensure that nearby organs like the stomach and duodenum receive less than 55 Gy to minimize the risk of severe complications. Doses above 55 Gy increase the risk of severe gastrointestinal issues in approximately one-third of patients. Long-term complications may include strictures and chronic inflammation at the treatment site.

Brachytherapy for gallbladder cancer requires a comprehensive and collaborative approach among healthcare professionals to optimize patient outcomes. Various specialists, including radiation oncologists, medical physicists, interventional radiologists, surgical oncologists, radiation therapists, and specialized nursing staff, are needed to provide effective and compassionate care to patients. Each member of the interprofessional team brings unique skills and knowledge essential for the effective planning, delivery, and follow-up care required by brachytherapy. Radiation oncologists oversee the treatment, ensuring the correct dose and placement of radioactive sources. Medical physicists are responsible for planning the radiation dose and ensuring the accuracy and safety of the treatment. Interventional radiologists perform the catheter placement using imaging, and surgical oncologists may be involved in cases where surgical resection is part of the treatment plan. Radiation therapists assist in delivering the treatment, and specialized nursing staff provide patient care before, during, and after the procedure. Effective interprofessional communication is important to ensure clear information exchange and collaborative decision-making. Regular team meetings and case discussions allow for the sharing of insights and coordination of care plans. This communication ensures that each team member is aware of their responsibilities and can contribute effectively. For example, during pretreatment simulations, medical physicists and radiation oncologists work together to verify the catheter path and adjust the setup. This collaboration ensures low friction and proper reach of the afterloader.