Radiation therapy for bile duct cancer

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is often used to treat extrahepatic bile duct cancer. Your healthcare team will consider your personal needs to plan the type and amount of radiation, and when and how it is given. You may also receive other treatments.

Radiation therapy is often combined with chemotherapy to treat bile duct cancer. This is called chemoradiation. The 2 treatments are given during the same time period.

Radiation therapy is given for different reasons. You may have radiation therapy or chemoradiation to:

• kill cancer cells that may still remain when the tumour is removed by surgery
• kill as many cancer cells as possible if surgery cannot be used to remove the tumour
• relieve pain or control the symptoms of advanced bile duct cancer (called palliative therapy)

Few research studies support the effectiveness of radiation therapy in treating extrahepatic bile duct cancer after surgery. It's not clear if this treatment helps people live longer. Because extrahepatic bile duct cancer is so rare, few people have had treatment with radiation therapy in these situations, which it makes it difficult to fully evaluate.

So there are no set standards of radiation therapy to treat bile duct cancers. It may be used to treat bile duct cancers starting outside the liver (extrahepatic). Radiation therapy is often given along with chemotherapy as chemoradiation for unresectable extrahepatic bile duct cancers. An extrahepatic bile duct tumour can block the bile duct and cause jaundice or pain if the tumour presses on nerves. Palliative radiation or chemoradiation may be used to shrink a tumour and help relieve symptoms.

Chemoradiation therapy may also be used after surgery if cancer cells are found in the surgical margins. Radiation therapy is not usually used to treat bile duct cancers inside the liver (intrahepatic).

The following types of radiation therapy may be used to treat bile duct cancer.

Radiation is given, during surgery, directly to the area from where the tumour was removed. Radiation is given as a single high dose using special devices.

During external beam radiation therapy, a machine directs radiation through the skin to the tumour and some of the tissue around it.

Brachytherapy is internal radiation therapy. It uses a radioactive material called a radioactive isotope. It is placed right into, or very close to, the tumour. Radioactive materials can also be placed in the area from where the tumour was removed. The radiation kills the cancer cells over time.

Side effects can happen with any type of treatment for bile duct cancer, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

During radiation therapy, the healthcare team protects healthy cells in the treatment area as much as possible. But damage to healthy cells can happen and may cause side effects. Side effects can happen any time during, immediately after or a few days or weeks after radiation therapy. Sometimes late side effects develop months or years after radiation therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of radiation therapy will depend mainly on the size of the area being treated, the specific area or organs being treated, the total dose of radiation and the treatment schedule. Side effects can be more severe when chemotherapy is given with radiation therapy. When chemoradiation is given, you may also have side effects of the chemotherapy drug used.

Some common side effects of radiation therapy used for bile duct cancer are:

• skin problems
• nausea and vomiting
• loss of appetite
• indigestion
• diarrhea
• fatigue

Cholangitis is inflammation of the bile ducts. People who have radiation therapy for extrahepatic bile duct cancer may develop mild or severe cholangitis. This is more likely to occur when brachytherapy (intraluminal radiation therapy) is used. Symptoms of cholangitis include fever, jaundice and pain in the upper-right part of the abdomen. The doctor may prescribe antibiotics and anti-inflammatory drugs to treat this condition.

Tell your healthcare team if you have these side effects or others you think might be from radiation therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Find out more about radiation therapy and side effects of radiation therapy. To make the decisions that are right for you, ask your healthcare team questions about radiation therapy.