Evolving role of radiation therapy in advanced/metastatic intrahepatic cholangiocarcinoma

Figure 1 Post stereotactic body radiation therapy response in a case of intrahepatic cholangiocarcinoma. A: Pre-stereotactic body radiation therapy (SBRT) positron emission tomography/computed tomography: Metabolically active ill-defined hypodense lesions with heterogeneous peripheral arterial enhancement and central necrotic changes involving segments VIII and V suggestive of intrahepatic cholangiocarcinoma; B: Stereotactic body radiation therapy colorwash; C: Positron emission tomography/computed tomography (post SBRT and three cycles of Gemcitabine /cisplatin base chemotherapy): There is significant interval reduction in metabolic activity of the primary lesion along with mild interval reduction in size of the lesion with appearance of central necrotic changes. SBRT: Stereotactic body radiation therapy.

Figure 2 Immunomodulatory effects of stereotactic body radiation therapy. TNF: Tumor necrosis factor; DC: Dendritic cells; TAA: Tumor-associated antigen; PD-1: Programmed cell death-1 receptor; CTLs: Cytotoxic T lymphocytes.