Liver Lesions
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The CyberKnife® Radiosurgery Solution
Cholangiocarcinoma
Due to the rarity of this tumor type, stereotactic radiotherapy literature is sparse, though prolonged local control of cholangiocarcinoma following stereotactic radiotherapy has been reported (25).
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.
Written by Donald B. Fuller, M.D. – Radiation Oncologist