How do you sequence hypofractionated radiation and systemic therapy for patients with unresectable cholangiocarcinoma?

I have generally cared for patients analogously to that done in the initial NRG GI001 or ABC07 trial designs with the use of initial systemic therapy for 3-6 months followed by consolidative RT targeting a BED > 80.5, assuming a/b ratio of 10 Gy. Tao et al., PMID 26503201

In my practice, it’s most c...

If one defines the standard of care by what most people do, they start with chemotherapy for someone who cannot have surgery for IHCC. However, logically since ablative radiation controls these to the same degree that surgery does, it is also reasonable to start with radiation and I have done that. ...

Our institutional approach depends on the initial risk for widespread disease.

In patients who would otherwise be potentially cured with surgery (i.e., localized intrahepatic disease), we treat all areas of involvement with ablative radiotherapy. We usually offer observation after this. If there is ...