Emerging Techniques in Image-Guided Radiation Therapy and Stereotactic Body Radiation Therapy

Abstract

Locoregional recurrence is the primary failure pattern for biliary tract and gallbladder cancers. However, the use of external beam radiation therapy in the treatment for these cancers, particularly cholangiocarcinoma, has had limited efficacy historically due to the high risk of toxicity with curative doses. While a range of anatomic locations and thus dose-limiting structures exist, proximity to the duodenum, risk of biliary stricture, and radiation-induced liver disease (RILD) have posed special challenges to achieving a dose capable of preventing local recurrence or achieving cure. Over the last decade, the rapid development and integration of technologies such as advanced onboard imaging (OBI) integrated with stereotactic body radiation therapy (SBRT) have created renewed interest in the use of external beam radiation in both the adjuvant and palliative setting for these cancers. In this chapter, we review the relevant advances, particularly the growing experience with SBRT in intrahepatic cholangiocarcinoma (ICC).