Radiotherapy and Brachytherapy for Unresectable Cholangiocarcinoma

Cholangiocarcinoma is a rare cancer arising from the bile ducts and carrying a poor prognosis. Radical surgery is the gold standard treatment and the only potential cure for this cancer but less than half of the tumours are resectable at the time of diagnosis. The role of radiotherapy or chemoradiotherapy remains undefined due to the lack of randomized phase three trials. The only randomized study on chemoradiation versus chemotherapy was a phase II trial comparing chemotherapy (gemcitabine plus oxaliplatin) with chemoradiation (50 Gy plus concurrent 5-fluorouracil plus cisplatin) in locally advanced biliary tract cancer. Unfortunately, the trial was closed before completion due to slow recruitment. Radiation therapy, chemotherapy and/or chemoradiation can be used in patients with non-resectable disease in an attempt to downstage the tumour, palliate symptoms and extend survival. Further studies are needed to better define the role of radiotherapy in the setting of advanced biliary cancers. 