Unresectable hilar cholangiocarcinoma completely reduced by external radiation therapy

A 68-year-old woman was referred to our hospital with liver dysfunction. Abdominal ultrasonography showed an isoechoic mass in the hepatic hilum. Abdominal computed tomography (CT) disclosed a homogenous mass adjacent to the portal bifurcation, and endoscopic retrograde choledocho-pancreatography (ERCP) revealed complete obstruction from the common hepatic duct to the hepatic duct confluence. After insertion of the endoscopic nasobiliary drainage (ENBD) tube, laparotomy was performed, revealing an approximately 5x6-cm elastic hard mass at the hepatic hilum, mainly spreading to the left hepatic duct, and involving surrounding vascular structures such as the portal vein and right and left hepatic arteries. Therefore, she was treated by external radiation therapy (ERT) of 60 Gy in 30 sessions after insertion of endoscopic retrograde biliary drainage (ERBD) tubes to bilateral hepatic ducts to replace the ENBD tube. After the completion of ERT, she was discharged from the hospital in good health. Three months later, she was readmitted for cholangitis and received antibiotic treatment. Surprisingly, abdominal CT disclosed complete remission of the tumor. ERCP revealed patency of the common hepatic duct and hepatic duct confluence. Therefore, the ERBD tubes were removed. Specimens from the hepatic duct confluence, and bilateral hepatic ducts showed no malignancy histologically. She is doing well without recurrence more than 4 years after surgery.