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Background: This study presents the joint experience of three centres in the treatment of patients with biliary tract (BT) tumours with radiation therapy (RT). Methods: Records of 27 patients, treated with RT from 2007 through 2013, were retrospectively reviewed. There were 14 males and 13 females aged 46-86years. Findings: Tumour location was the extrahepatic BT in 14 patients, the intrahepatic BT in four patients, and the perihilar region in nine patients. Nineteen patients were diagnosed with adenocarcinoma. A curative resection was performed in 16 patients, 11 of whom had microscopically involved surgical margins. All of these patients received postoperative RT. The remaining 11 patients received palliative RT. Median RT dose was 50.4Gy. Twenty patients with adequate performance status were treated with RT and chemotherapy, and the remaining seven patients were treated with RT alone. Follow-up ranged from 1month to 44months (median 17months). Local recurrence was observed in five out of the 16 patients who received postoperative RT at 4-23months (median, 7months). Eight patients developed distant metastases at 5-16months (median 8months). Fifteen patients died due to disease-related causes at 1-22months (median 9months). At 2years, overall survival was 33% and local failure-free survival was 33%. A curative resection predicted improved survival and improved local failure-free survival on univariate analysis. Local control was not achieved in 10 of the 11 patients who received palliative RT. Interpretation: In patients with inoperable BT tumours, outcomes after palliative RT were not satisfactory. For patients undergoing curative resection followed by postoperative RT, local recurrence was the leading cause of treatment failure. Therefore, indications, doses, and the target volume for postoperative RT should be reconsidered. [ABSTRACT FROM AUTHOR]