Postoperative endoscopic retrograde high dose-rate brachytherapy for cholangiocarcinoma

Cholangiocarcinoma typically presents with disease unlikely to be completel y resected, and prognosis remains poor. Improvements in imaging, endoscopy, and stenting have given rise to renewed interest in brachytherapy. Several recent retrospective series suggest a benefit to intraluminal brachytherap y, most commonly delivered by the transhepatic route. We describe a case in which brachytherapy was delivered via the nasobiliary route to address pos itive margins at the common bile duct stump. A custom catheter was manufact ured to make the procedure feasible. Pertinent literature is reviewed, whic h supports the view that these malignancies benefit from high doses of radi ation, if this can be achieved respecting normal tissue tolerance.