Sharma D, Meena BL. Evolving role of radiation therapy in advanced/metastatic intrahepatic cholangiocarcinoma. World J Gastrointest Pharmacol Ther 2025; 16(4): 109304 [DOI: 10.4292/wjgpt.v16.i4.109304]
Corresponding Author of This Article
Deepti Sharma, Associate Professor, Department of Radiation Oncology, Institute of Liver and Biliary Sciences, New Delhi 110070, India. drdeeptisharma16@gmail.com
Research Domain of This Article
Oncology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Pharmacol Ther. Dec 5, 2025; 16(4): 109304 Published online Dec 5, 2025. doi: 10.4292/wjgpt.v16.i4.109304
Evolving role of radiation therapy in advanced/metastatic intrahepatic cholangiocarcinoma
Deepti Sharma, Babu Lal Meena
Deepti Sharma, Department of Radiation Oncology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
Babu Lal Meena, Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Co-first authors: Deepti Sharma and Babu Lal Meena.
Author contributions: Sharma D and Meena BL contributed equally to the article's concept, design, and writing; both authors approved the manuscript and its submission to the journal.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed following the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Deepti Sharma, Associate Professor, Department of Radiation Oncology, Institute of Liver and Biliary Sciences, New Delhi 110070, India. drdeeptisharma16@gmail.com
Received: May 7, 2025 Revised: May 30, 2025 Accepted: August 27, 2025 Published online: December 5, 2025 Processing time: 212 Days and 19.3 Hours
Abstract
This review evaluates the role of stereotactic body radiation therapy (SBRT) in advanced/metastatic intrahepatic cholangiocarcinoma (iCCA), highlighting its efficacy, integration with systemic therapy, and potential for resection or transplantation. SBRT is emerging as a transformative, non-invasive treatment for iCCA, extending beyond palliation. SBRT with a biologically effective dose > 75 Gy improves survival in unresectable iCCA, with median overall survival (mOS) of 15-24 months, significantly surpassing lower-dose regimens. Advanced motion management techniques like fiducial tracking and gating achieve > 70% local control at 1 year. In metastatic iCCA, hypo-fractionated SBRT provides symptom relief with mOS of 6-9 months and reduced toxicity. Neoadjuvant SBRT increases R0 resection rates to 60%-75% in borderline resectable cases, compared to 30%-40% with chemotherapy alone. SBRT combined with systemic therapy expands eligibility for liver transplantation, achieving 3-year post-transplant survival > 65%. SBRT is a transformative therapy for iCCA, improving control, survival, and eligibility for curative treatments. Further research is needed to optimize protocols and patient selection.
Core Tip: This review explores the transformative role of radiation therapy, including stereotactic body radiation therapy (SBRT), in managing intrahepatic cholangiocarcinoma, an aggressive malignancy with limited treatment options. With advances in radiation delivery, motion management, and systemic therapy integration, SBRT is evolving beyond palliation to improve local control, survival outcomes, and potential synergy with transplantation strategies.
