For inoperable cholangiocarcinoma, do you recommend up-front chemotherapy prior to offering SBRT or combination chemoradiation?  

For inoperable cholangiocarcinoma, there are many factors to consider. First, does the patient have any metastatic disease? If no, then how large is the primary and are there any nodes? Finally, is the patient suffering from biliary obstruction - causing hyperbilirubinemia and persistent/recurrent c...