Would you recommend radiation or chemoradiation in a patient with cholangiocarcinoma s/p surgery and adjuvant treatment with single hepatic metastasis 3 years later?

Challenging case and worthy of tumor board discussion. I would likely start systemic therapy, and if response, consider regional therapy with resection or SBRT, assuming the hepatic function is adequate (keep in mind, TARE can cause liver disease). I have one patient in a similar situation, now > 5 ...

Considering post-TARE dosimetry using PET imaging to see the dose to the tumor and uninvolved liver, there are several software programs doing this, including MIM. Often, TARE delivers a non-uniform dose to the large liver tumor. One then generates a treatment plan for proton (or carbon, not availab...