• Bile duct cancer
• Extrahepatic
• Guidlines

• Radiotherapy (RT)
• biliary cancer
• cholangiocarcinoma

• Advanced bile duct carcinoma
• Photodynamic therapy
• Semiconductor laser
• Talaporfin sodium

• Aged
• Aged, 80 and over
• Bile Duct Neoplasms/drug therapy
• Carcinoma/drug therapy
• Female
• Humans
• Low-Level Light Therapy
• Photochemotherapy/methods
• Photosensitizing Agents/therapeutic use
• Porphyrins/therapeutic use

The emerging data for stenting in combination with brachytherapy in unresectable hilar cholangiocarcinoma are encouraging. The aim of this study was to evaluate the efficacy and safety of radiation-emitting metallic stents (REMS) for unresectable Bismuth type III or IV hilar cholangiocarcinoma.

Consecutive patients who underwent percutaneous placement with REMS or uncovered self-expandable metallic stent (SEMS) for unresectable Bismuth type III or IV hilar cholangiocarcinoma between September 2011 and April 2016 were identified into this retrospective study. Data on patient demographics and overall survival, functional success, stent patency and complications were collected at the authors’ hospital.

A total of 59 patients were included: 33 (55.9%) in the REMS group and 26 (44.1%) in the SEMS group. The median overall survival was 338 days in the REMS group and 141 days in the SEMS group (p<0.001). The median stent patency time was 385 days for REMS and 142 days for SEMS (p<0.001). The functional success rate (87.9% vs 84.6%, p=0.722) and incidence of overall complications (27.3% vs 26.9%, p=0.999) did not differ in the two groups.

Placement with REMS is safe and effective in palliation for unresectable Bismuth type III or IV hilar cholangiocarcinoma, and seems to prolong survival as well as patency of stent in these patients.

• brachytherapy.
• cholangiocarcinoma
• jaundice
• palliation
• stent

• Panax ginseng Meyer
• apoptosis
• oxidative stress
• radiation-induced liver injury

The benefits of radiotherapy for inoperable biliary tract cancer remain unclear due to the lack of randomized data. We evaluated the impact of radiotherapy on survival in elderly patients using the SEER‐Medicare database. Patients in the SEER‐Medicare database with inoperable biliary tract tumors diagnosed between 1998 and 2011 were included. We used multivariate logistic regression to evaluate factors associated with treatment selection, and multivariate Cox regression and propensity score matching to evaluate treatment selection in relation to subsequent survival. Of the 2343 patients included, 451 (19%) received radiotherapy within 4 months of diagnosis. The use of radiotherapy declined over time, and was influenced by receipt of chemotherapy and patient age, race, marital status, poverty status, and tumor stage and type. Median survival was 9.3 (95% CI 8.7–9.7) months among patients who did not receive radiation and 10.0 (95% CI 9.1–11.3) months among those who received radiation, conditional on having survived 4 months. In patients who received chemotherapy (n = 1053), receipt of radiation was associated with improved survival, with an adjusted hazard ratio of 0.82 (95% 0.70–0.97, P = 0.02). In patients who did not receive chemotherapy (n = 1290), receipt of radiation was not associated with improved survival, with an adjusted hazard ratio of 1.09 (95% 0.91–1.30, P = 0.34). Propensity‐scored matched analyses showed similar results. Despite the survival benefit associated with the addition of radiotherapy to chemotherapy, the use of radiation for unresectable biliary tract cancers has declined over time.

• Chemoradiation
• SEER-Medicare
• cholangiocarcinoma
• elderly
• gallbladder

Patients with cholangiocarcinoma usually present at an advanced stage, and more than 50% of cases are not resectable at the time of diagnosis. Recently, photodynamic therapy (PDT) has been proposed as a palliative and neoadjuvant modality. We evaluated whether combination of PDT and chemotherapy is more effective than PDT alone.

In total, 161 patients with cholangiocarcinoma diagnosed between February 1999 and September 2009 were evaluated. Sixteen patients were treated with PDT and chemotherapy (group A), and 58 were treated with PDT (group B).

The median survival was 538 days (95% confidence interval [CI], 475.3 to 600.7) in group A and 334 days (95% CI, 252.5 to 415.5) in group B (p=0.05). Lymph node metastasis status, serum bilirubin of pretreatment, tumor node metastasis stage, treatment method (PDT with chemotherapy vs PDT alone), time to PDT and the number of PDT sessions were prognostic factors with statistical significance in the univariate analysis. A multivariate analysis showed that PDT with chemotherapy and more than two sessions of PDT were significant independent predictors of longer survival in advanced cholangiocarcinoma (hazard ratio [HR], 2.23; 95% CI, 1.18 to 4.20; p=0.013 vs HR, 1.79; 95% CI, 1.044 to 3.083; p=0.034).

PDT with chemotherapy results in longer survival than PDT alone.

• Cholangiocarcinoma
• Drug therapy
• Photochemotherapy

• Photodynamic therapy (PDT)
• access route
• bile duct carcinoma (BDC)
• endoscopy
• transhepatic
• transjejunal
• transpapillary

Hilar cholangiocarcinoma (HC) is a rare tumor that causes devastating disease. In the late stages, this carcinoma primarily invades the portal vein and metastasizes to the hepatic lobes; it is associated with a poor prognosis. HC is diagnosed by its clinical manifestation and results of imaging techniques such as ultrasound, computed tomography, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiography, and percutaneous transhepatic cholangiography. Preoperative hepatic bile drainage can improve symptoms associated with insufficient liver and kidney function, coagulopathy, and jaundice. Surgical margin-negative (R0) resection, including major liver resection, is the most effective and potentially curative treatment for HC. If the tumor is not resected, then liver transplantation with adjuvant management can improve survival. We conducted a systematic review of developments in imaging studies and major surgical hepatectomy for HC with positive outcomes regarding quality of life.

• Biliary metal stent
• Malignant biliary obstruction
• Radiotherapy
• Stent patency

The most common form in bile duct cancers is a highly desmoplastic cancer with a growth pattern characterized by periductal extension and infiltration. The prognosis of bile duct cancers, especially hilar cholangiocarcinoma, is limited by tumor spread along the biliary tree leading to refractory obstructive cholestasis, cholangitis, and liver failure. Although biliary endoprosthesis improves occlusion rates and reduces the number of therapeutic interventions, median survival time is not ameliorated. Photodynamic therapy (PDT) is a local photochemical tumor treatment that consists of a photosensitizing agent in combination with laser irradiation of a distinct wavelength. Tumor ablation with PDT combined with biliary stenting reduces cholestasis and significantly improves median survival time in selected patients with bile duct cancers.

• Bile duct neoplasms
• Cholangiocarcinoma
• Endoprosthesis
• Photodynamic therapy
• Photosensitizing agents

• cholangiocarcinoma
• hilar
• multimodality
• outcome
• perihilar

• Bile Duct Neoplasms/diagnosis
• Bile Duct Neoplasms/etiology
• Bile Duct Neoplasms/therapy
• Bile Ducts, Intrahepatic
• Cholangiocarcinoma/diagnosis
• Cholangiocarcinoma/etiology
• Cholangiocarcinoma/therapy
• Cholangiopancreatography, Endoscopic Retrograde
• Combined Modality Therapy
• Endoscopy, Digestive System
• Humans
• Magnetic Resonance Imaging
• Multidetector Computed Tomography
• Positron-Emission Tomography
• Risk Factors

• P30 CA006973 NCI NIH HHS

AIM: To determine the efficacy of external beam radiotherapy (EBRT), with or without intraluminal brachytherapy (ILBT), in patients with non-resected locally advanced hilar cholangiocarcinoma.

METHODS: We analyzed 64 patients with locally advanced hilar cholangiocarcinoma, including 25 who underwent resection (17 curative and 8 non-curative), 28 treated with radiotherapy, and 11 who received best supportive care (BSC). The radiotherapy group received EBRT (50 Gy, 30 fractions), with 11 receiving an additional 24 Gy (4 fractions) ILBT by iridium-192 with remote after loading. ILBT was performed using percutaneous transhepatic biliary drainage (PTBD) route. Uncovered metallic stents (UMS) were inserted into non-resected patients with obstructive jaundice, with the exception of four patients who received percutaneous transhepatic biliary drainage only. UMS were placed endoscopically or percutaneously, depending on the initial drainage procedure. The primary endpoints were patient death or stent occlusion. Survival time of patients in the radiotherapy group was compared with that of patients in the resection and BSC groups. Stent patency was compared in the radiotherapy and BSC groups.

RESULTS: No statistically significant differences in patient characteristics were found among the resection, radiotherapy, and BSC groups. Three patients in the radiotherapy group and one in the BSC group did not receive UMS insertion but received PTBD alone; cholangitis occurred after endoscopic stenting, and patients were treated with PTBD. A total of 16 patients were administered additional systemic chemotherapy (5-fluorouracil-based regimen in 9, S-1 in 6, and gemcitabine in 1). Overall survival varied significantly among groups, with median survival times of 48.7 mo in the surgery group, 22.1 mo in the radiotherapy group, and 5.7 mo in the BSC group. Patients who underwent curative resection survived significantly longer than those who were not candidates for surgery (P = 0.0076). Cumulative survival in the radiotherapy group was significantly longer than in the BSC group (P = 0.0031), but did not differ significantly from those in the non-resection group. Furthermore, the median survival time of patients in the radiotherapy group who were considered for possible resection (excluding the seven patients who were not candidates for surgery due to comorbid disease or age) was 25.9 mo. Stent patency was evaluated only in the 24 patients who received a metallic stent. Stent patency was significantly longer in the radiotherapy than in the BSC group (P = 0.0165). Biliary drainage was not eliminated in any patient. To determine the efficacy of ILBT, we compared survival time and stent patency in the EBRT alone and EBRT plus ILBT groups. However, we found no significant difference in survival time between groups or for stent patencies. Hemorrhagic gastroduodenal ulcers were observed in 5 patients (17.9%), three in the EBRT plus ILBT group and two in the EBRT alone group. Ulcers occurred 5 mo, 7 mo, 8 mo, 16 mo, and 29 mo following radiotherapy. All patients required hospitalization, but blood transfusions were unnecessary. All 5 patients recovered following the administration of anti-ulcer medication.

CONCLUSION: Radiotherapy improved patient prognosis and the patency of uncovered metallic stents in patients with locally advanced hilar cholangiocarcinoma, but ILBT provided no additional benefits.

• Hilar cholangiocarcinoma
• Radiotherapy
• Intra-luminal brachytherapy
• Biliary metallic stent
• Obstructive jaundice

• bile duct cancer
• palliative endoscopic stenting
• percutaneous transhepatic cholangioscopy
• outcome
• survival

• Adult
• Aged
• Aged, 80 and over
• Bile Duct Neoplasms/drug therapy
• Bile Duct Neoplasms/mortality
• Bile Duct Neoplasms/pathology
• Bile Duct Neoplasms/therapy
• Bile Ducts, Intrahepatic/pathology
• Cholangiocarcinoma/drug therapy
• Cholangiocarcinoma/mortality
• Cholangiocarcinoma/pathology
• Cholangiocarcinoma/therapy
• Combined Modality Therapy
• Drainage/adverse effects
• Drainage/instrumentation
• Drainage/mortality
• Endoscopy/adverse effects
• Endoscopy/instrumentation
• Endoscopy/mortality
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasm Staging
• Photochemotherapy/adverse effects
• Photochemotherapy/mortality
• Proportional Hazards Models
• Republic of Korea
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Stents
• Therapeutics
• Time Factors

• Bile duct neoplasms
• Cholangiocarcinoma
• Photodynamic therapy
• Photosensitizing agents

• Bile Duct Neoplasms/drug therapy
• Bile Ducts, Intrahepatic
• Cholangiocarcinoma/drug therapy
• Humans
• Photochemotherapy
• Treatment Outcome

Cholangiocarcinoma is the primary malignancy arising from the biliary epithelium. The disease is marked by jaundice, cholestasis, and cholangitis. Over 50 percent of patients present with advanced stage disease, precluding curative surgical resection as an option of treatment. Prognosis is poor, and survival has been limited even after biliary decompression. Palliative management has become the standard of care for unresectable disease and has evolved to include an endoscopic approach. Photodynamic therapy (PDT) consists of administration of a photosensitizer followed by local irradiation with laser therapy. Several studies conducted in Europe and the United States have shown a marked improvement in the symptoms of cholestasis, survival, and quality of life. This article summarizes the published experience regarding PDT for cholangiocarcinoma and the steps required to administer this therapy safely.

• Cholangiocarcinoma
• Cholestasis
• Jaundice
• Neoplasia
• Palliation
• Photodynamic therapy
• Photofrin

• Biliary cancer
• Cholangiocarcinoma
• Photodynamic therapy

• Animals
• Bile Duct Neoplasms/blood
• Bile Duct Neoplasms/diagnosis
• Bile Duct Neoplasms/mortality
• Bile Duct Neoplasms/physiopathology
• Bile Duct Neoplasms/therapy
• Bile Ducts, Intrahepatic/pathology
• Biomarkers, Tumor/blood
• Brachytherapy/adverse effects
• Cholangiocarcinoma/blood
• Cholangiocarcinoma/diagnosis
• Cholangiocarcinoma/mortality
• Cholangiocarcinoma/physiopathology
• Cholangiocarcinoma/therapy
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Contraindications
• Drainage
• Humans
• Palliative Care/methods
• Photochemotherapy/adverse effects
• Stents/adverse effects

• hilar cholangiocarcinoma
• survival
• curative surgery
• photodynamic therapy

Several advances in diagnosis, treatment and palliation of cholangiocarcinoma (CC) have occurred in the last decades. A multidisciplinary approach to this disease is therefore recommended. CC is a relatively rare tumor and the main risk factors are: chronic inflammation, genetic predisposition and congenital abnormalities of the biliary tree. While the incidence of intra-hepatic CC is increasing, the incidence of extra-hepatic CC is trending down. The only curative treatment for CC is surgical resection with negative margins. Liver transplantation has been proposed only for selected patients with hilar CC that cannot be resected who have no metastatic disease after a period of neoadjuvant chemo-radiation therapy. Magnetic resonance imaging/magnetic resonance cholangiopancreatography, positron emission tomography scan, endoscopic ultrasound and computed tomography scans are the most frequently used modalities for diagnosis and tumor staging. Adjuvant therapy, palliative chemotherapy and radiotherapy have been relatively ineffective for inoperable CC. For most of these patients biliary stenting provides effective palliation. Photodynamic therapy is an emerging palliative treatment that seems to provide pain relief, improve biliary patency and increase survival. The clinical utility of other emerging therapies such as transarterial chemoembolization, hepatic arterial chemoinfusion and high intensity intraductal ultrasound needs further study.

• Cholangiocarcinoma
• Epidemiology
• Diagnosis
• Therapy
• Palliation
• Systematic review

• Bile Duct Neoplasms/drug therapy
• Cholangiocarcinoma/drug therapy
• Clinical Trials as Topic
• Hepatic Duct, Common/pathology
• Humans
• Klatskin Tumor/drug therapy
• Photochemotherapy/methods

Cholangiocarcinoma (CC) is a devastating cancer arising from biliary epithelia. Unfortunately, the incidence of this disease is increasing in Western countries. These tumors progress insidiously, and liver failure, biliary sepsis, malnutrition and cancer cachexia are general modes of death associated with this disease. To date, no established therapy for advanced disease has been established or validated. However, our knowledge in tumor biology is increasing dramatically and new drugs are under investigation for treatment of this notorious tumor. In clinical practice, there are better diagnostic tools in use to facilitate an earlier diagnosis of CC, at least in those patients with known risk factors. CC is resectable for cure in only a small percentage of patients. Preoperative staging for vascular and biliary extension of CC is very important in this tumor. Laparoscopy and recently endosonography seem to protect against unnecessary laparotomies in these patients. During the last 15 years, aggressive surgical approaches, including combined liver resections and vascular reconstructive surgical expertise, have improved survival in patients with CC. Surgery is contraindicated in CC cases having primary sclerosing cholangitis (PSC). Although CC was previously considered a contraindication to liver transplantation, new cautious protocols, including neo-adjuvant chemoradiation therapies and staging procedures before the transplantation, have made it possible to achieve long-term survival after liver transplantation in this disease. New ablative therapies with photodynamic therapy, intraductal high-intensity ultrasonography and chemotherapy-impregnated plastic biliary endoprosthesis are important steps in the palliative management of extra-hepatic CCs. Radiofrequency and chemo-embolization methods are also applicable for intra-hepatic CCs as palliative modes of treatment. We need more prospective randomized controlled trials to evaluate the role of the new emerging therapies for CC patients.

• Cholangiocarcinoma
• Primary sclerosing cholangitis
• Radiofrequency ablation
• Chemoembolization

Cholangiocarcinoma is the second most common primary hepatic cancer. Despite advances in diagnostic techniques during the past decade, cholangiocarcinoma is usually encountered at an advanced stage. In this review, we describe the classification, diagnosis, and initial management of cholangiocarcinoma with obstructive jaundice.

• Cholangiocarcinoma
• Obstructive jaundice
• Diagnosis
• Treatment
• Initial management

• Aged
• Antineoplastic Agents
• Bile Duct Neoplasms/drug therapy
• Bile Duct Neoplasms/mortality
• Bile Ducts, Intrahepatic
• Cholangiocarcinoma/drug therapy
• Cholangiocarcinoma/mortality
• Cholangiopancreatography, Endoscopic Retrograde
• Cholangiopancreatography, Magnetic Resonance
• Female
• Hematoporphyrin Photoradiation
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Photosensitizing Agents/therapeutic use
• Retrospective Studies
• Serum Albumin/analysis
• Survival Analysis

• R01CA097048 NCI NIH HHS
• R01 CA111603 NCI NIH HHS
• CA111603 NCI NIH HHS
• CA85992 NCI NIH HHS
• R01 CA097048 NCI NIH HHS

• Biliary Tract Neoplasms/complications
• Biliary Tract Neoplasms/radiotherapy
• Brachytherapy
• Cholestasis/etiology
• Cholestasis/therapy
• Drainage
• Endoscopy, Digestive System
• Female
• Humans
• Male
• Metals
• Middle Aged
• Palliative Care
• Radiotherapy Dosage
• Stents

AIM: To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma.

METHODS: Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995–2005. Of the 96 patients, 20 were initially treated with surgery (n = 2 R0 / n = 18 R1). In non-operated patients, data analysis was performed retrospectively.

RESULTS: Among the 96 patients, 76 were treated with endoscopic transpapillary (ERC, n = 45) and/or percutaneous transhepatic biliary drainage (PTBD, n = 31). The mean survival time of these 76 patients undergoing palliative endoscopic and/or percutaneous drainage was 359 ± 296 d. The mean survival time of patients with initial bilirubin levels > 10 mg/dL was significantly lower (P < 0.001) than patients with bilirubin levels < 10 mg/dL. The mean survival time of patients with Bismuth stage II (n = 8), III (n = 28) and IV (n = 40) was 496 ± 300 d, 441 ± 385 d and 274 ± 218 d, respectively. Thus, patients with advanced Bismuth stage showed a reduced mean survival time, but the difference was not significant. The type of biliary drainage had no significant beneficial effect on the mean survival time (ERC vs PTBD, P = 0.806).

CONCLUSION: Initial bilirubin level is a significant prognostic factor for survival of patients. In contrast, age, tumor stage according to the Bismuth-Corlette classification, and types of intervention are not significant prognostic parameters for survival. Palliative treatment with endoscopic or percutaneous biliary drainage is still suboptimal, new diagnostic and therapeutic tools need to be evaluated.

• Klatskin tumor
• Cholangiocarcinoma
• Bilirubin
• Prognostic factors
• Endoscopic therapy
• Operative therapy
• Survival
• Bismuth stage

• Aged
• Bile Duct Neoplasms/blood
• Bile Duct Neoplasms/diagnosis
• Bile Duct Neoplasms/therapy
• Bile Ducts, Intrahepatic
• Bilirubin/blood
• Cholangiocarcinoma/blood
• Cholangiocarcinoma/diagnosis
• Cholangiocarcinoma/therapy
• Endoscopy, Gastrointestinal
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Neoplasm Staging
• Predictive Value of Tests
• Prognosis
• Retrospective Studies
• Survival Analysis
• Treatment Outcome

• Adult
• Aged
• Aged, 80 and over
• Bile Duct Neoplasms/radiotherapy
• Bile Duct Neoplasms/surgery
• Bile Ducts, Intrahepatic/pathology
• Bile Ducts, Intrahepatic/radiation effects
• Bile Ducts, Intrahepatic/surgery
• Biliary Tract Surgical Procedures/instrumentation
• Brachytherapy/methods
• Cholangiocarcinoma/radiotherapy
• Cholangiocarcinoma/surgery
• Combined Modality Therapy
• Female
• Follow-Up Studies
• Humans
• Iridium Radioisotopes/therapeutic use
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Prospective Studies
• Radiotherapy Dosage
• Stents
• Treatment Outcome

• Biliary Tract Neoplasms/diagnosis
• Biliary Tract Neoplasms/therapy
• Biopsy, Needle
• Cholangiography
• Cholangiopancreatography, Endoscopic Retrograde
• Endoscopy, Digestive System
• Endosonography
• Humans
• Pancreatic Neoplasms/diagnosis
• Pancreatic Neoplasms/therapy

• Bile Duct Neoplasms/drug therapy
• Bile Ducts, Intrahepatic
• Cholangiocarcinoma/drug therapy
• Clinical Trials as Topic
• Guidelines as Topic
• Humans
• Photochemotherapy/methods
• Photosensitizing Agents/therapeutic use

• Administration, Oral
• Aged
• Antineoplastic Combined Chemotherapy Protocols/adverse effects
• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Bile Duct Neoplasms/drug therapy
• Bile Duct Neoplasms/radiotherapy
• Bile Ducts, Extrahepatic
• Combined Modality Therapy
• Female
• Floxuridine/administration & dosage
• Humans
• Infusions, Intravenous
• Male
• Middle Aged
• Paclitaxel/administration & dosage
• Survival Analysis
• Treatment Outcome

• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Bile Duct Neoplasms/drug therapy
• Bile Duct Neoplasms/mortality
• Bile Duct Neoplasms/radiotherapy
• Bile Duct Neoplasms/surgery
• Brachytherapy
• Chemotherapy, Adjuvant
• Cholangiocarcinoma/drug therapy
• Cholangiocarcinoma/mortality
• Cholangiocarcinoma/radiotherapy
• Cholangiocarcinoma/surgery
• Cholestasis/drug therapy
• Cholestasis/mortality
• Cholestasis/radiotherapy
• Cholestasis/surgery
• Combined Modality Therapy
• Deoxycytidine/administration & dosage
• Deoxycytidine/adverse effects
• Deoxycytidine/analogs & derivatives
• Hepatic Duct, Common/surgery
• Humans
• Jejunostomy
• Neoadjuvant Therapy
• Palliative Care
• Photochemotherapy
• Radiotherapy, Adjuvant
• Stents
• Survival Rate
• Gemcitabine

• Adult
• Aged
• Analysis of Variance
• Antimetabolites, Antineoplastic/therapeutic use
• Bile Duct Neoplasms/drug therapy
• Bile Duct Neoplasms/mortality
• Bile Duct Neoplasms/radiotherapy
• Bile Ducts, Extrahepatic
• Brachytherapy/adverse effects
• Combined Modality Therapy
• Female
• Fluorouracil/therapeutic use
• Humans
• Iridium Radioisotopes/therapeutic use
• Male
• Middle Aged
• Prognosis
• Radiotherapy Dosage

• Cholangiocarcinoma/drug therapy
• Gastrointestinal Neoplasms/drug therapy
• Humans
• Photochemotherapy
• Precancerous Conditions/drug therapy

• Animals
• Biliary Tract Neoplasms/drug therapy
• Carcinoma/drug therapy
• Cell Death
• Clinical Trials as Topic
• Humans
• Immune System/drug effects
• Pancreatic Neoplasms/drug therapy
• Photochemotherapy
• Prognosis

• Bile Duct Neoplasms/diagnosis
• Bile Duct Neoplasms/pathology
• Bile Duct Neoplasms/surgery
• Cholangiocarcinoma/diagnosis
• Cholangiocarcinoma/pathology
• Cholangiocarcinoma/surgery
• Cholangiopancreatography, Endoscopic Retrograde
• Endosonography
• Humans
• Stents

• Bile Duct Neoplasms/complications
• Bile Duct Neoplasms/radiotherapy
• Bile Ducts, Intrahepatic
• Brachytherapy/methods
• Cholangiocarcinoma/complications
• Cholangiocarcinoma/radiotherapy
• Cholestasis/etiology
• Cholestasis/radiotherapy
• Female
• Humans
• Jaundice, Obstructive/etiology
• Jaundice, Obstructive/radiotherapy
• Middle Aged