Bile Duct (Cholangiocarcinoma) Cancer

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Treating Bile Duct Cancer TOPICS

Radiation therapy for bile duct cancer

Radiation therapy is treatment with high-energy rays or particles that destroy cancer cells. The 2 main types of radiation therapy are external beam radiation and brachytherapy. These may be used in different settings to treat bile duct cancer:

After surgery for resectable cancers: This is known as adjuvant therapy. It is meant to kill any tiny deposits of cancer cells that remain after surgery (but are too small to see). Some doctors believe adjuvant radiation therapy is helpful, but more research is needed to confirm this.

As treatment before surgery for borderline resectable cancers: Some doctors may use radiation therapy before surgery for certain cancers that are thought to be resectable. This is done to try to shrink the cancer and make the operation easier and is known as neoadjuvant therapy. It's not clear how helpful this is.

As part of the main therapy for some advanced cancers: Radiation therapy can also be used as a main therapy for some patients whose cancer has not spread widely throughout the body, but is not resectable. While treatment in this case does not offer a cure, it may help patients to live longer.

Radiation therapy may be given along with chemotherapy (chemo) to help it work better. This is called chemoradiation. Most often, the chemo drugs used are 5-fluorouracil (5-FU) or capecitabine (Xeloda®). The main drawback of this approach is that the side effects tend to be worse than giving radiation alone.

As palliative therapy: Radiation therapy is often used to palliate (relieve) symptoms when a patient's cancer is too advanced to be cured. It may be used to relieve pain or other symptoms by shrinking tumors that block passageways for blood or bile, or press on nerves.

External beam radiation therapy (EBRT)

This type of radiation therapy uses x-rays from a machine outside the patient's body to kill cancer cells. It is the most common form of radiation therapy for bile duct cancer. The treatment is much like getting an x-ray, but the radiation is more intense. The procedure itself is painless. Before your treatments start, the radiation team will take careful measurements to determine the correct angles for aiming the radiation beams and the proper dose of radiation. Each treatment lasts only a few minutes, but the setup time -- getting you into place for treatment -- usually takes longer. Most often, radiation treatments are given 5 days a week for several weeks.

Standard (conventional) EBRT is used much less often than in the past. With newer techniques, doctors can more accurately treat bile duct cancers while reducing the radiation exposure to nearby healthy tissues. This may offer a better chance of increasing the success rate and reducing side effects.

Three-dimensional conformal radiation therapy (3D-CRT) uses special computers to precisely map the location of the tumor(s). Radiation beams are shaped and aimed at the tumor(s) from several directions, which makes it less likely to damage normal tissues. Most doctors now recommend using some form of 3D-CRT when it is available.

Intensity-modulated radiation therapy (IMRT) is an advanced form of 3D therapy. It uses a computer-driven machine that actually moves around the patient as it delivers radiation. In addition to shaping the beams and aiming them at the bile duct from several angles, the intensity (strength) of the beams can be adjusted to minimize the dose reaching the most sensitive normal tissues. This lets doctors deliver an even higher dose to the cancer areas. This procedure is available in many major hospitals and cancer centers.

Stereotactic body radiotherapy (SBRT) uses the techniques of 3D-CRT and IMRT, but gives the radiation over fewer sessions. A course of SBRT may take less than a week, while a course of radiation using these other techniques often takes place over 3 to 6 weeks.

EBRT side effects

Side effects of external beam radiation therapy depend on the area of the body being treated. Some common side effects include:

  • Skin changes, ranging from redness to blistering and peeling (in the area being treated)
  • Nausea and vomiting
  • Diarrhea
  • Fatigue (tiredness)
  • Hair loss (on the skin in the area being treated)
  • Low blood counts

Nausea, vomiting, and diarrhea are more common if the abdomen (belly) is being treated.

Low blood counts include low white blood cell counts, which can lead to an increased risk of serious infection. Red blood cell counts can also become low. This is called anemia, and can lead to a person becoming pale and feeling weak and tired.

Side effects from radiation often start a week or 2 into treatment, and improve once treatment is over.

Brachytherapy (internal radiation therapy)

This type of treatment uses small pellets of radioactive material placed next to or directly into the cancer. The radiation travels a very short distance, so it affects the cancer without causing much harm to nearby healthy body tissues. Brachytherapy is sometimes used in treating people with bile duct cancer by placing the pellets in a tube, which is inserted into the bile duct for a short time.

For more general information about radiation therapy, please see our document, Understanding Radiation Therapy: A Guide for Patients and Families.


Last Medical Review: 10/30/2013
Last Revised: 10/30/2013