Cholangiocarcinoma (CCA) is a rare cancer of bile ducts. It is associated with a poor prognosis. The incidence of CCA is rising worldwide. Anatomical subgroups have been used to classify patients for treatment and prognosis. There is a growing understanding of clinically important distinctions based on underlying genetic differences that lead to different treatment options and outcomes. Its management is further complicated by a heterogeneous population and relative rarity, which limits the conduct of large trials to guide management. Surgery has been the primary method of therapy for localized disease; however, recurrence and death remain high with or without surgery. Therefore, there have been concerted efforts to investigate new treatment options, such as the use of neoadjuvant treatments to optimize surgical outcomes, targeted therapy, leveraging a new understanding of immunobiology and stereotactic radiation. In this narrative review, we address the evidence to improve suboptimal outcomes in unresectable CCA with radiation, as well as the role of radiation in neoadjuvant and postoperative treatment. We also briefly discuss the recent developments in systemic treatment with targeted therapies and immune checkpoint inhibitors.
胆管癌是一种罕见的胆道恶性肿瘤，预后较差，全球发病率呈上升趋势。传统上根据解剖亚型对患者进行分类以指导治疗和预后评估。随着对基因差异认识的深入，基于不同基因特征的临床分型正为个体化治疗方案选择和预后判断提供新依据。该疾病因患者群体异质性高且相对罕见，导致大规模临床试验难以开展，进一步增加了治疗决策的复杂性。 手术是局限性病变的主要治疗手段，但无论是否接受手术，患者复发率和死亡率仍居高不下。为此，医学界正积极探索新的治疗策略，包括采用新辅助治疗优化手术疗效、靶向治疗、基于免疫生物学新认知的疗法以及立体定向放疗等。本文通过叙述性综述，系统探讨放疗在改善不可切除胆管癌患者疗效方面的证据，以及放疗在新辅助治疗和术后辅助治疗中的作用，并简要概述靶向治疗与免疫检查点抑制剂等全身治疗的最新进展。
The Current Role of Radiation in the Management of Cholangiocarcinoma—A Narrative Review
肿瘤(癌症)患者之家