Procedure
Radiation therapy focuses high-energy X-rays on the tumor inside the body to specifically kill it. Radiotherapy can also be used if the bile duct cancer has already spread: radiotherapy can then prevent or alleviate symptoms caused by metastases or the bile duct cancer itself(palliative radiotherapy).
Radiotherapy is carried out as an outpatient treatment, is non-invasive (i.e. does not require anesthesia) and can therefore be easily integrated into everyday private life. Depending on the extent of the tumor, radiotherapy can be carried out in a few treatment sessions as body stereotactic radiotherapy (SBRT) for small tumor foci, or as fractionated treatment over several weeks for larger tumors and before planned transplantation. Sometimes radiotherapy is combined with chemotherapy to improve its effectiveness. Close and personal support is a matter of course for us.
The Department of Radiation Oncology at the USZ uses only the most modern techniques to irradiate bile duct cancer as precisely as possible and with as few side effects as possible. You will be looked after by proven experts in the treatment of bile duct cancer.
We work closely with our colleagues in surgery and medical oncology to guarantee treatment from a single source.
For many patients, we are already offering the treatment of tomorrow: in clinical trials, we are continuously working on improving the treatment of bile duct cancer to make it even more effective and tolerable. To the overview of currently open studies.
In the following, we will describe radiotherapy for the different types and stages of bile duct cancer:
Liver transplantation for bile duct cancer
Liver transplantation is a promising treatment option for perihilar cholangiocarcinoma. We treat patients at the USZ according to the so-called Mayo protocol. This protocol was developed at the Mayo Clinic in the USA. Before the liver transplant, the bile duct cancer is irradiated and chemotherapy is administered to reduce the likelihood of a recurrence. Radiation is carried out in a total of 28 sessions over approximately 6 weeks. Radiation is combined with tablet chemotherapy.
If possible, a few sessions are carried out on our special device, the MR-LINAC, which combines MRI imaging and radiation. The integrated MRI allows a very detailed representation of the actual anatomy. The position of the tumor and the surrounding healthy organs can thus be determined with millimeter precision every day and the radiation can – if necessary – be optimally adapted to the current situation immediately. We can also use MRI technology to monitor tumor and organ mobility “live” during radiation. Our clinic was the first in Switzerland to introduce this technology back in 2019. We are still the only clinic in German-speaking Switzerland to offer the highest level of expertise in this field.
Bile duct cancer after an operation
Surgery for bile duct cancer is usually followed by additional chemotherapy after the operation to eliminate any cancer cells that may have spread. In the case of incomplete resection, additional irradiation of the surgical site may be useful, especially if the area of incomplete resection can be precisely localized. In this case, the radiation is divided into many small “portions”: the therapy is fractionated over 28 treatment sessions every working day over a period of around 6 weeks. Spreading the radiation treatment over several weeks improves the tolerability of the treatment, which is mainly carried out on an outpatient basis and can be integrated into the patient’s everyday life. This radiation is often combined with additional low-dose chemotherapy, either in the form of tablets or infusions.
Metastases of bile duct cancer, e.g. in the brain or bones
Bile duct cancer is an aggressive type of cancer that often forms metastases during the course of the disease: this is called metastasis. Common sites of metastasis are the lung, adrenal gland, bones, liver or brain. Radiotherapy is a highly effective method with few side effects to prevent or treat symptoms caused by metastases. This is usually done in combination with chemotherapy, immunotherapy or other targeted therapy. The smaller the metastases are and the earlier they are irradiated, the better the results. Today, metastases in the body can be treated in a focused manner in just a few effective radiation sessions.
For tumor foci in the abdominal area, e.g. liver or upper abdomen, we carry out body stereotactic radiotherapy (SBRT) on our MRI hybrid accelerator. State-of-the-art radiation technology is combined with MRI images. The radiation is thus carried out under MRI monitoring of the tumor, so that the highest precision is combined with the best imaging. Our clinic was the first in Switzerland to introduce this technology back in 2019. We are still the only clinic in German-speaking Switzerland to offer the highest level of expertise in this field.
Today, brain metastases are treated at our center in most patients by means of a single high-dose radiation treatment: this is called radiosurgery. Metastases at other locations in the body can now also be treated in a focused manner in just a few effective radiation sessions. Metastatic bile duct cancer is a clinical and scientific focus of our clinic. We pass on our knowledge in a large number of international courses and congresses. We are active as international experts in guideline commissions.
State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety. At the same time, we work closely with our colleagues in medical oncology to guarantee “one-stop” treatment. We also consult with our colleagues in palliative medicine at an early stage.
In clinical trials, we are continuously trying to improve the treatment of bile duct cancer in order to make it even more effective and tolerable. To the overview of currently open studies.
