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Thonglert et al. Hepatoma Res 2023;9:40 Hepatoma Research
DOI: 10.20517/2394-5079.2023.47

Review Open Access

Advanced and emerging radiation therapy

approaches for intrahepatic cholangiocarcinoma

3
3
1,2
Kanokphorn Thonglert , Michael D. Chuong , Robert Herrera , Smith Apisarnthanarax 1
1
Departmen of Radiation Oncology, University of Washington, Seattle, WA 98115, USA.
2
Division of Radiation Oncology, Department of Radiation, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn
Memorial Hospital, Bangkok 10330, Thailand.
3
Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA.
Correspondence to: Smith Apisarnthanarax, MD, Department of Radiation Oncology, University of Washington, 1959 NE Pacific
St, Seattle, WA 98115, USA. E-mail: apisarn@uw.edu
How to cite this article: Thonglert K, Chuong MD, Herrera R, Apisarnthanarax S. Advanced and emerging radiation therapy
approaches for intrahepatic cholangiocarcinoma. Hepatoma Res 2023;9:40. https://dx.doi.org/10.20517/2394-5079.2023.47

Received: 15 May 2023 First Decision: 19 Jul 2023 Revised: 26 Jul 2023 Accepted: 14 Aug 2023 Published: 18 Aug 2023
Academic Editor: Roberto Ivan Troisi Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Radiotherapy (RT) is an integral component of the multidisciplinary care for intrahepatic cholangiocarcinoma
(iCCA). Over the past decades, RT techniques have been developed with the aim of enhancing tumor control and
minimizing toxicity. The most recent technological advancements include proton beam therapy (PBT) and
magnetic resonance-guided radiotherapy (MRgRT). PBT is notable for its unique physical characteristics that allow
for greater sparing of surrounding normal organs, especially the liver, from low to moderate doses of radiation.
MRgRT provides advantages in other aspects, including superior tumor visualization before treatment, on-board
treatment plan adaptation, and tumor tracking during treatment. These features allow for precise dose delivery and
safe dose escalation, especially for patients with tumors close to luminal GI structures. In this review article, the
rationale, clinical outcomes, clinical applications, challenges, and future directions of PBT and MRgRT are
discussed. Additionally, the potential combination of novel therapeutics with RT in iCCA is explored.

Keywords: Adaptive radiotherapy, cholangiocarcinoma, intrahepatic cholangiocarcinoma, MR-guided radiotherapy,
proton beam therapy, radiotherapy

INTRODUCTION
Intrahepatic cholangiocarcinoma (iCCA) is a relatively rare cancer characterized by an unfavorable long-

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