In stage 4 hilar cholangiocarcinoma, after stenting the biliary tree is there value in radiating the hilar area in addition to systemic therapy so as to maintain patency of the biliary system for a longer period of time or do you depend on the systemic therapy and the stenting alone?

In the setting of metastatic hilar cholangiocarcinoma, biliary patency is one issue but the greater issue is colonization of the biliary tree with gut flora that leads to repeated bouts of cholangitis, and progressive biliary sclerosis that happens regardless of the use of radiation. These patients ...