31Survival Outcomes in Cholangiocarcinoma Patients Treated with Radiation Therapy
Tzipora Schein, Michael BucksteinAbstract
Background & Objectives
Cholangiocarcinoma is a rare and aggressive biliary tract cancer. Although surgery offers the best chance for long-term survival, most patients are not surgical candidates at diagnosis. Radiation therapy (RT) is often used for local tumor control, but data on optimal RT technique and integration with systemic therapies are limited. This study evaluated overall survival (OS) and progression-free survival (PFS) in patients treated with RT and assessed potential prognostic factors.
Methods
This retrospective review included patients with cholangiocarcinoma treated with RT between 2015 and 2025. Survival was estimated using the Kaplan-Meier method, and log-rank tests compared outcomes by disease stage, lymph node involvement, RT technique (fractionated RT vs stereotactic body RT [SBRT]), immunotherapy use (durvalumab), and time from diagnosis to RT.
Results
Thirty-eight patients met inclusion criteria. The cohort was 55% female and 45% male, with a median age of 66 years. Median OS for the cohort was 23.0 months from diagnosis, and median PFS was 11.0 months. Disease stage and lymph node involvement were not statistically significant. Patients treated with durvalumab had median OS and PFS that were not reached, compared with 22.0 months (p = 0.41) and 8.0 months (p = 0.33) in those without immunotherapy. Patients treated with SBRT had a median PFS of 29.0 months versus 8.0 months for fractionated RT (p = 0.23), and median OS was not reached in the SBRT group versus 23.0 months for fractionated RT (p = 0.11). Longer time from diagnosis to RT showed a trend toward improved OS (p = 0.07).
Conclusion
RT for cholangiocarcinoma was associated with a median overall survival of nearly two years. Although limited by sample size, observed trends suggest potential survival benefits with SBRT and durvalumab. The association between longer time to RT and improved survival likely reflects selection bias. Larger studies are needed to further define optimal RT technique and integration of immunotherapy in cholangiocarcinoma management.