Would you recommend radiation or chemoradiation in a patient with cholangiocarcinoma s/p surgery and adjuvant treatment with single hepatic metastasis 3 years later?
Patient with extrahepatic cholangiocarcinoma s/p Whipple in 2021 with negative margins and no positive nodes followed by adjuvant chemo with subsequent recurrence in the right hepatic lobe in 2024 now s/p Y 90 radioembolization with further disease progression of the single metastatic site now 8.3 cm in size.
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For patient with an isolated but large liver metastasis, what would be your recommendation, assuming patient can tolerate all treatments but disease is unresectable?
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2 Answers
Mednet MemberInvited Expert
Medical Oncology · Mayo Clinic
Answered on
Challenging case and worthy of tumor board discussion. I would likely start systemic therapy, and if response, consider regional therapy with resection or SBRT, assuming the hepatic function is adequate (keep in mind, TARE can cause liver disease). I have one patient in a similar situation, now > 5 ...
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Mednet Member
Radiation Oncology · University of Illinois, College of Medicine
Answered on
Considering post-TARE dosimetry using PET imaging to see the dose to the tumor and uninvolved liver, there are several software programs doing this, including MIM. Often, TARE delivers a non-uniform dose to the large liver tumor. One then generates a treatment plan for proton (or carbon, not availab...
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