Application of Immunoenhancing Radiotherapy in Treating Unresectable Intrahepatic Cholangiocarcinoma: A Case Report

Unresectable intrahepatic cholangiocarcinoma currently lacks standard treatment methods. This report presents a case where PET/CT scans showed a subcapsular mass in the right posterior lobe of the liver measuring 6.2 cm × 3.7 cm × 3.8 cm, and a soft tissue nodule in the apicoposterior segment of the left upper lung lobe measuring 1.2 cm × 1.3 cm × 1.4 cm, both exhibiting increased glucose metabolism. A biopsy of the liver lesion confirmed well-differentiated cholangiocarcinoma, classified as Stage IV (cT1bN0M1). The patient, supported by their family, declined chemotherapy, surgery, immune checkpoint inhibitor therapy, and targeted therapy. Following a multidisciplinary team discussion, the patient was treated with conformal intensity-modulated radiotherapy aimed at the hepatic lesion, delivering a total dose of 50 Gy in ten sessions (5 Gy per session, once daily, five times per week). This was combined with 300 µg of granulocyte-macrophage colony-stimulating factor (GM-CSF), subcutaneously injected daily from the first to the tenth day of radiotherapy. No subsequent treatments were administered; only follow-up evaluations were performed. MRI assessments at three, twelve-, and twenty-four months post-treatment showed progressive reduction in the size of the hepatic primary lesion, with decreases of 15%, 36%, and 53% from baseline, respectively, and no growth in the pulmonary lesion. This outcome suggests that radiotherapy paired with an immunoadjuvant could be a viable treatment alternative for patients with unresectable intrahepatic cholangiocarcinoma.