Long-term survival following chemoradiotherapy for postoperative recurrence of hilar cholangiocarcinoma

Standard treatment for metastatic biliary tract cancer is systemic chemotherapy, not local therapy, such as surgery or radiation therapy. This is because long-term survival is not expected with local therapy. We present the case of a 49-year-old man who underwent extended right hepatectomy with extrahepatic bile duct resection for hilar cholangiocarcinoma. Postoperative adjuvant chemotherapy with oral S-1 for six months was completed. At 20 months post-operation, para-aortic lymphadenopathy was detected, and endoscopic ultrasound-guided biopsy confirmed lymph node recurrence. Gemcitabine and cisplatin were administered for six months, resulting in partial tumor regression. As no other lesions were identified, radiotherapy with a total dose of 55 Gy in 22 fractions was performed. At 37 months following the completion of radiotherapy, the patient remained disease-free based on imaging. This case suggests that the addition of local radiotherapy to systemic chemotherapy may be beneficial for patients with oligometastatic recurrence of hilar cholangiocarcinoma.