***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE Intrahepatic cholangiocarcinomas ( IHC ) are rare tumors for which large r and omized studies regarding the use of radiation are not available . The purpose of this study was to examine the role of adjuvant and definitive radiation therapy in the treatment of IHC in a large group of patients . METHODS AND MATERIAL S This is a retrospective analysis of 3,839 patients with IHC collected from the Surveillance , Epidemiology , and End Results ( SEER ) data base . The primary endpoint was overall survival ( OS ) . RESULTS Patients received either surgery alone ( 25 % ) , radiation therapy alone ( 10 % ) , surgery and adjuvant radiation therapy ( 7 % ) or no treatment ( 58 % ) . The median age of the patient population was 73 years ( range , 22 - 102 years ) ; 52 % of patients were male and 81 % were Caucasian .  Median OS was 11 ( 95 % confidence interval [ CI ] , 9 - 13 ) , 6 ( 95 % CI , 5 - 6 ) , 7 ( 95 % CI , 6 - 8 ) , and 3 months for surgery and adjuvant radiation therapy , surgery alone , radiation therapy alone , and no treatment , respectively . The OS was significantly different between surgery alone and surgery and adjuvant radiation therapy ( p = 0.014 ) and radiation therapy alone and no treatment ( p < 0.0001 ) . Use of surgery and adjuvant radiation therapy conferred the greatest benefit on OS ( HR = 0.40 ; 95 % CI , 0.34 - 0.47 ) , followed by surgery alone ( hazard ratio [ HR ] , 0.49 ; 95 % CI , 0.44 - 0.54 ) and radiation therapy alone ( HR , 0.68 ; 95 % CI , 0.59 - 0.77 ) compared with no treatment , on multivariate analysis . Propensity score adjusted hazard ratios ( controlling for age , race/ethnicity , stage , and year of diagnosis ) were also significant ( surgery and adjuvant radiation therapy vs. surgery alone ( HR , 0.82 ; 95 % CI , 0.70 - 0.96 ) ; radiation therapy alone vs. no treatment ( HR , 0.67 ; 95 % CI , 0.58 - 0.76 ) ) . CONCLUSIONS The study results suggest that adjuvant and definitive radiation treatment prolong survival , although cure rates remain low . Future studies should evaluate the addition of chemotherapy and biologics to the treatment of IHC PURPOSE An analysis was performed on patients enrolled in a phase 1 - 2 trial using  stereotactic body radiation therapy for hepatocellular carcinoma evaluating variables influencing liver toxicity . METHODS AND MATERIAL S Thirty-eight Child-Pugh class A ( CPC-A ) ( 39 lesions ) and 21 CPC-B patients ( 26 lesions ) were followed for ≥6 months . Six months local control using modified Response Evaluation Criteria in Solid Tumors criteria , progression-free survival , overall survival , and grade III/IV treatment-related toxicity at 3 months were analyzed . RESULTS Median follow-up was 33.3 months ( 2.8 - 61.1 months ) for CPC-A and 46.3 months ( 3.7 - 70.4 months ) for CPC-B patients . Local control at 6 months was 92 % for CPC-A and 93 % for CPC-B. Kaplan-Meier estimated 2- and 3-year local control was 91 % for CPC-A and 82 % for CPC-B ( P = .61 ) . Median overall survival was 44.8 months and 17.0 months for CPC-A and CPC-B. Kaplan-Meier estimated 2- and 3-year overall survival was 72 % and 61 % for CPC-A and 33 % and 26 % for CPC-B ( P = .03 ) . Four ( 11 % ) CPC-A patients and 8 CPC-B patients ( 38 % ) experienced grade III/IV liver toxicity . Overall , CPC-A patients with ≥ grade III liver toxicity had 4.59 ( 95 % confidence interval , 1.19 - 17.66 ) times greater risk of death than those without toxicity ( P = .0268 ) . No such correlation was seen for CPC-B patients ; however , 3 of these CPC-B patients underwent orthotopic liver transplant . CPC-B patients experiencing grade III/IV liver toxicity had significantly higher mean liver dose , higher dose to one-third normal liver , and larger volumes of liver receiving doses < 2.5 to 15 Gy in 2.5-Gy increments . For CPC-A patients , there was no critical liver dose or volume constraint correlated with toxicity . CONCLUSIONS In our experience , liver stereotactic body radiation therapy is a safe therapy for patients with hepatocellular carcinoma in the context of liver cirrhosis ; however , for CPC-B patients , careful attention should be paid to low-dose volumes that could potentially result in increased liver toxicity PURPOSE To evaluate the efficacy and safety of high-dose , hypofractionated proton beam therapy for hepatocellular carcinoma ( HCC ) and intrahepatic cholangiocarcinoma ( ICC ) . MATERIAL S AND METHODS In this single-arm , phase II , multi-institutional study , 92 patients with biopsy-confirmed HCC or ICC , determined to be unresectable by multidisciplinary review , with a Child-Turcotte-Pugh score ( CTP ) of A or B , ECOG performance status of 0 to 2 , no extrahepatic disease , and no prior radiation received 15 fractions of proton therapy to a maximum total dose  of 67.5 Gy  equivalent . Sample size was calculated to demonstrate > 80 % local control ( LC ) defined by Response Evaluation Criteria in Solid Tumors ( RECIST ) 1.0 criteria at 2 years for HCC patients , with the parallel goal of obtaining acceptable precision for estimating outcomes for ICC . RESULTS Eighty-three patients were evaluable : 44 with HCC , 37 with ICC , and two with mixed HCC/ICC . The CTP score was A for 79.5 % of patients and B for 15.7 % ; 4.8 % of patients had no cirrhosis . Prior treatment had been given to 31.8 % of HCC patients and 61.5 % of ICC patients . The median maximum dimension was 5.0 cm ( range , 1.9 to 12.0 cm ) for HCC patients and 6.0 cm ( range , 2.2 to 10.9 cm ) for ICC patients . Multiple tumors were present in 27.3 % of HCC patients and in 12.8 % of ICC patients . Tumor vascular thrombosis was present in 29.5 % of HCC patients and in 28.2 % of ICC patients . The median dose delivered to both HCC and ICC patients was 58.0 Gy . With a median follow-up among survivors of 19.5 months , the LC rate at 2 years was 94.8 % for HCC and 94.1 % for ICC . The overall survival rate at 2 years was 63.2 % for HCC and 46.5 % ICC . CONCLUSION High-dose hypofractionated proton therapy demonstrated high LC rates for HCC and ICC safely , supporting ongoing phase III trials of radiation in HCC and ICC BACKGROUND & AIMS Photodynamic therapy ( PDT ) for unresectable cholangiocarcinoma is associated with improvement in cholestasis , quality of life , and potentially survival . We compared survival in patients with unresectable cholangiocarcinoma undergoing endoscopic retro grade cholangiopancreatography ( ERCP ) with PDT and stent placement  with a group undergoing ERCP with stent placement alone .  METHODS Forty-eight patients were palliated for unresectable cholangiocarcinoma during a 5-year period . Nineteen were treated with PDT and stents ;  29 patients treated with biliary stents alone served as a control group . Multivariate analysis was performed by using Model for End-Stage Liver Disease score , age , treatment by chemotherapy or radiation , and number of ERCP procedures and PDT sessions to detect predictors of survival . RESULTS Kaplan-Meier analysis demonstrated improved survival in the PDT group compared with the stent only group ( 16.2 vs 7.4 months , P<.004 ) . Mortality in the PDT group at 3 , 6 , and 12 months was 0 % , 16 % , and 56 % , respectively . The corresponding mortality in the stent group was 28 % , 52 % , and 82 % , respectively . The difference between the 2 groups was significant at 3 months and 6 months but not at 12 months . Only the number of ERCP procedures and number of PDT sessions were significant on multivariate analysis . Adverse events specific to PDT included 3 patients with skin phototoxicity requiring topical therapy only . CONCLUSIONS ERCP with PDT seems to increase survival in patients with unresectable cholangiocarcinoma when compared with ERCP alone . It remains to be proved whether this effect is attributable to PDT or the number of ERCP sessions . A prospect i ve r and omized multicenter study is required to confirm these data PURPOSE To report outcomes of a phase I study of individualized stereotactic body radiotherapy treatment ( SBRT ) for unresectable hepatocellular carcinoma ( HCC ) and intrahepatic cholangiocarcinoma ( IHC ) . PATIENTS AND METHODS Patients with unresectable HCC or IHC , and who are not suitable for st and ard therapies , were eligible for six-fraction SBRT  during 2 weeks . Radiation dose was dependent on the volume of liver irradiated and the estimated risk of liver toxicity based on a normal tissue complication model . Toxicity risk was escalated from 5 % to 10 % and 20 % , within three liver volume-irradiated strata , provided at least three patients were without toxicity at 3 months after SBRT . RESULTS Forty-one patients with unresectable Child-Pugh A HCC ( n = 31 ) or IHC ( n = 10 ) completed six-fraction SBRT . Five patients ( 12 % ) had grade 3  liver enzymes  at baseline . The median tumor size was 173 mL ( 9 to 1,913 mL ) . The median dose was 36.0 Gy ( 24.0 to 54.0 Gy ) . No radiation-induced liver disease or treatment-related grade 4/5 toxicity was seen within 3 months after SBRT . Grade 3 liver enzymes were seen in five patients ( 12 % ) . Two patients ( 5 % ) with IHC developed transient biliary obstruction after the first few fractions . Seven patients ( five HCC , two IHC ) had decline in liver function from Child-Pugh class A to B within 3 months after SBRT . Median survival of HCC and IHC patients was 11.7 months ( 95 % CI , 9.2 to 21.6 months ) and 15.0 months ( 95 % CI , 6.5 to 29.0 months ) , respectively . CONCLUSION Individualized six-fraction SBRT is a safe treatment for unresectable HCC and IHC BACKGROUND / AIMS Because proximal bile duct cancer easily involves the surrounding tissue , tumor cells often remain after apparent macroscopically complete radical resection . We evaluated the effect of resective modality of these tumors on prognosis and the effect of postoperative radiotherapy on survival of patients with microscopic residual tumor following local resection in locally advanced proximal bile duct cancer . METHODOLOGY From November , 1990 to October , 1993 , 45 proximal bile duct cancer patients who received local excision were entered onto this prospect i ve , nonr and omized study . The patients were divided into three groups after operation , 16 patients with curative resection ; 15 noncurative resection ; and 14 nonresection .  Patients who had positive lymph nodes or microscopic cancer cells in resection margin or adjacent major vessels , were treated with postoperative external radiotherapy , 5040 cGy for 40 days . RESULTS The overall 1- , 2- , and 5-year survival of the patients was 62.2 % , 24.4 % , and 15.6 % , respectively . The overall mean and median survival of patients was 24.1 + /- 3.98 ( mean + /- SE ) months and 13 + /- 0.74 months , respectively . Survival rates between resection and nonresection showed a statistically significant difference ( P < 0.05 ) . However , survival rates between curative resection and noncurative resection with postoperative radiotherapy were not statistically significant ( P > 0.05 ) . CONCLUSIONS The resection is the treatment of choice for locally advanced proximal bile duct cancer , if resectable and the noncurative resection followed by postoperative external radiotherapy may be beneficial to the patients with locally advanced proximal bile duct cancer PURPOSE A phase II trial was conducted to determine if high-dose radiation with concurrent hepatic arterial floxuridine would improve survival in patients with unresectable intrahe 
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Conclusions SBRT was a feasible treatment option with respect to achieving a high LC for unresectable or recurrent CC .
Gastrointestinal toxicity is acceptable , but remains an obstacle related to dose escalation .
Die häufigsten Toxizitäten waren Ulcus duodeni und Ulcus ventriculi in den verfügbaren Studien mit einer akuten Inzidenz von Grad ≥3 unter 10 % und einer späten Inzidenz von 10 bis 20 % .SchlussfolgerungenDie SBRT war eine machbare Beh and lungsoption in Bezug auf die Erreichung einer hohen LC bei inoperablen oder rezidivierenden CC .