Radiotherapy as a component of multidisciplinary treatment of bile duct cancer: a surgeon's perspective

Surgery is the only curative treatment for bile duct cancer (BDC). However, because of frequent loco-regional recurrence, radical surgery during advanced stages of the disease is often unsuccessful. Despite recent evidence of improvement in patient survival and quality of life, alternatives such as radiation therapy have not been fully developed and remain controversial. This article reviews current publications that deal with various irradiation procedures for the treatment of BDC, with particular attention to adjuvants to surgical resection, including liver transplantation, as a component of treatment of BDC. Specialized boost techniques, including conformal external beam irradiation (EBRT), brachytherapy via transhepatic catheters or a retrograde endoscopic stent, or intraoperative irradiation with electrons (IOERT), are summarized in relation to patient survival.