Stereotactic ablative radiotherapy is a promising and noninvasive treatment option for patients with nonresectable cholangiocarcinoma, according to a new Danish study published in Acta Oncologica. The approach has the added benefits of offering a short treatment time and having acceptable toxicity. 

“[Stereotactic ablative radiotherapy] should be considered for fragile patients not suited for standard chemotherapy and not eligible for clinical trials,” the authors said.

The aim of the study was to investigate the effect of stereotactic ablative radiotherapy on survival in patients with cholangiocarcinoma.

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The team assessed 41 patients with cholangiocarcinoma who were treated with stereotactic ablative radiotherapy at the Aarhus University Hospital in Denmark between 2009 and 2018. 

They found that the median overall survival of the patients was 11.8 months. The 1-year overall survival rate was 48.8% and the 2-year overall survival rate was 19.5%. The 1-year progression-free survival rate was 31.7% while the 2-year progression-free survival rate was 9.8%. The median time to progression was 5.8 months.

The researchers calculated that there was a significant correlation between the overall survival time and the size of the tumor, with patients with a tumor smaller than 3.6 cm in diameter having longer overall survival times. However, there was no correlation between survival and the performance status, location of the tumor, or total dose of radiation used. 

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The researchers also reported that the treatment was well-tolerated overall. No patients had liver failure and there were no toxicity-related deaths. The most common toxicity was cholangitis, with 21 patients experiencing acute toxicity. 

There was a significant correlation between the presence of toxicity and age, with patients aged less than 69  years showing lower toxicity. There was also a significant correlation between the presence of toxicity and extrahepatic localization. However, there was no significant correlation between toxicity and gender, performance status, gross tumor volume, total radiation dose used, or comorbidities.

Future studies should aim to identify groups of patients with cholangiocarcinoma who could benefit from stereotactic ablative radiotherapy, the researchers said.


Thuehøj AU, Andersen NC, Worm ES, et al. Clinical outcomes after stereotactic ablative radiotherapy in locally advanced cholangiocarcinoma. Acta Oncol. 2021;2:1-5. doi:10.1080/0284186X.2021.1995893