How do you approach adjuvant radiation for perihilar cholangiocarinoma?

There should certainly be multi-disciplinary discussion, as while RT can augment locoregional control in the adjuvant setting and should strongly be considered, there is a paucity of high-level data. SWOG 0809 was the first prospective study (single-arm phase 2) of adjuvant therapy in stage pT2-4 or N+ or +margin biliary tract malignancies, utilizing adjuvant gem/cape chemotherapy followed by concurrent cape-RT, and showed the feasibility of prospective evaluation in a rare disease and established baseline outcomes with a commonly utilized approach. When treating in the adjuvant setting, the CTV is defined by the surgical bed and lymphatic drainage, with attention to altered normal anatomy. For hilar cholangiocarcinoma, resection involves t...