Neoadjuvant Radiation May Improve Tolerability in Cholangiocarcinoma

Ethan B. Ludmir, MD, an associate professor in the Department of Gastrointestinal Radiation Oncology at The University of Texas MD Anderson Cancer Center, spoke with CancerNetwork® ahead of the 2026 Chicago Cholangiocarcinoma Symposium about the rationale for moving radiation therapy into the neoadjuvant setting for borderline resectable or locally advanced cholangiocarcinoma.

Ludmir noted that most existing data support radiotherapy in the adjuvant setting, including the phase 2 SWOG S0809 trial (NCT00789958), where radiation served as a “cleanup crew” for patients with margin-positive resections or other adverse pathologic features. Drawing on experience in pancreatic cancer, a “sister disease” to distal extrahepatic cholangiocarcinoma, he explained that patients tend to tolerate neoadjuvant radiation better than adjuvant treatment and that preoperative radiation may improve the likelihood of an R0 resection. He also described variation in how surgeons view the effect of preoperative radiation on tissue planes around the vasculature.

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