Anatomically, cholangiocarcinomas may be more difficult to treat with stereotactic radiotherapy/radiosurgery than other liver lesions, due to their frequent close proximity to the stomach and small intestine. Even with a very focal radiation approach such as CyberKnife® radiosurgery, immediate approximation of the intestinal wall against the tumor volume predicts an increased risk of ulceration following treatment, warranting extreme caution in managing these tumors with focal ablative radiation approaches.

A sensible approach to cholangiocarcinoma would be to perform exploratory surgery with the intent of surgically removing the tumor if possible. If the tumor proves inoperable, a reasonable response would then be to surgically move sensitive gastrointestinal tissues away form the tumor bearing area, simultaneously implanting CyberKnife® targeting markers into the tumor for radiosurgery beam guidance. It would then be safer to proceed with CyberKnife® radiosurgery to the cholangiocarcinoma tumor, with consideration of more traditional radiotherapy and chemotherapy before or afterward, to deal with cancer cells that may have spread beyond the visible tumor.