Hepatobiliary Cancers

This chapter discusses the evaluation, management, role of radiotherapy, and the evolving role of particle therapy for patients with hepatobiliary cancers. Hepatobiliary cancers include hepatocellular carcinoma, gallbladder cancer, extrahepatic cholangiocarcinoma, and intrahepatic cholangiocarcinoma. The preferred treatment for patients with localized hepatobiliary cancers is surgical resection; however, the minority of patients are suitable for surgery due to the extent of disease at diagnosis or underlying comorbidities, including baseline liver dysfunction. There are a few series reporting results of proton therapy for patients with liver metastasis which demonstrate the early feasibility, safety, and efficacy of this strategy. Mild-to-moderate skin and chest-wall toxicity may be more common in patients receiving particle therapy when compared to patients receiving photon-based radiotherapy techniques, particularly for thinner patients with peripherally located tumors. Severe kidney injury is uncommon after radiotherapy for hepatobiliary cancers.