Radiation therapy for bile duct cancer
Radiation therapy uses high-energy rays or particles to destroy cancer cells. Radiation can 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.
- 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 live longer.
- As palliative therapy: Radiation therapy is often used to palliate (relieve) symptoms when a cancer is too advanced to be cured. It can help relieve pain or other symptoms by shrinking tumors that block passageways for blood or bile, or press on nerves.
Chemotherapy (chemo) is sometimes given along with the radiation therapy 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.
The 2 main types of radiation therapy are external beam radiation therapy (EBRT) and brachytherapy. EBRT is the most common form of radiation for bile duct cancer.
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.
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. The treatment is much like getting an x-ray, but the radiation is much stronger. The procedure itself is painless. 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.
Newer radiation techniques now let doctors more accurately treat bile duct cancers while reducing the radiation exposure to nearby healthy tissues. This may increase the success rate and help reduce side effects.
Three-dimensional conformal radiation therapy (3D-CRT) uses special computers to precisely map the location of the tumor(s). Radiation beams are then shaped and aimed at the tumor(s) from several directions, which makes it less likely to damage normal tissues.
Intensity-modulated radiation therapy (IMRT) is an advanced form of 3D therapy. It uses a computer-driven machine that moves around you as it delivers radiation. Along with shaping the beams and aiming them at the cancer from several angles, the intensity (strength) of the beams can be adjusted to limit the dose reaching the most sensitive normal tissues. This lets doctors deliver an even higher dose to the cancer areas. IMRT 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 EBRT 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
- Fatigue (tiredness)
- Hair loss (on the skin in the area being treated)
- Low blood cell counts
Nausea, vomiting, and diarrhea are more common if the abdomen (belly) is being treated.
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. For bile duct cancer, brachytherapy is sometimes done by placing the pellets in a tube, which is inserted into the bile duct for a short time.
Last Medical Review: 11/01/2014
Last Revised: 01/20/2016