If resection margins are not free, it should be assessed whether postoperative chemotherapy in combination with radiation therapy can be given. There are no prospective randomized studies showing increased survival with administration of adjuvant radiation therapy or chemo/radiation therapy for bile duct/gallbladder cancer. Retrospective studies indicate an increase in survival after radiotherapy when the surgical resection margins were not free from cancer.
For locally advanced inoperable cancer, the main problem is local progression of the tumor, not metastasis. Multiple radiation therapy studies and studies using combination regimens of chemotherapy and radiation have shown effectiveness for local control, pain, and biliary decompression. The effect of radiation therapy is probably dependent on a high radiation dose (> 55 Gy).
For locally advanced inoperable cancer, chemotherapy with or without combination with radiation therapy can be administered (1).