{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:50:14Z","timestamp":1789541414127,"version":"build-2803163510"},"reference-count":33,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2021,8,7]],"date-time":"2021-08-07T00:00:00Z","timestamp":1628294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: In unresectable pCCA, the standard of care is palliative chemotherapy. We investigated the feasibility and safety of adding stereotactic body radiation therapy (SBRT) after chemotherapy. Methods: Patients with unresectable pCCA, stage T1-T4N0-N1M0, ECOG 0-1, having finished 6\u20138 cycles of cisplatin and gemcitabine without disease progression were eligible. SBRT was planned in 15 fractions of 3.0\u20134.5 Gy. The primary endpoints were feasibility (defined as completing SBRT as planned) and toxicity, evaluated within 3 months after SBRT (CTCAE v4.03). A conventional \u201c3 + 3\u201d design was used, corresponding to a sample size of 6 patients. Dose-limiting toxicity (DLT) was defined as grade \u2265 4 hepatobiliary or grade \u2265 3 gastrointestinal toxicity. The secondary endpoints, measured from the start of radiotherapy, were local control, progression-free survival, overall survival, and quality of life (QoL). ClinicalTrials.gov identifier: NCT03307538. Results: Six patients were enrolled between November 2017 and March 2020. SBRT was delivered as planned. All patients were treated with 60Gy (15 \u00d7 4.0Gy). No SBRT-related DLT was observed. The most common grade \u2265 3 toxicity was cholangitis (n = 5). The median follow-up was 14 months. The 12-month local control rate was 80%. We observed no substantial changes in QoL. Conclusion: In patients with unresectable pCCA with stable disease after palliative chemotherapy, adding SBRT is feasible and safe. The observed local control merits an additional evaluation of effectiveness.<\/jats:p>","DOI":"10.3390\/cancers13163991","type":"journal-article","created":{"date-parts":[[2021,8,8]],"date-time":"2021-08-08T21:49:41Z","timestamp":1628459381000},"page":"3991","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Stereotactic Body Radiation Therapy after Chemotherapy for Unresectable Perihilar Cholangiocarcinoma: The STRONG Trial, a Phase I Safety and Feasibility Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Rogier","family":"Baak","sequence":"first","affiliation":[{"name":"Department of Radiotherapy, Erasmus MC Cancer Institute, 3015 CN Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8274-3881","authenticated-orcid":false,"given":"Fran\u00e7ois","family":"Willemssen","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, 3015 CN Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvette","family":"van Norden","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, Erasmus MC Cancer Institute, 3015 CN Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferry","family":"Eskens","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 CN Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maaike","family":"Milder","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, Erasmus MC Cancer Institute, 3015 CN Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Heijmen","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, Erasmus MC Cancer Institute, 3015 CN Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bas","family":"Koerkamp","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus MC University Medical Center, 3015 CN Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dave","family":"Sprengers","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, 3015 CN Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydi","family":"van Driel","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, 3015 CN Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heinz-Josef","family":"Kl\u00fcmpen","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, 1081 HV Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilhelm","family":"den Toom","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, Erasmus MC Cancer Institute, 3015 CN Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merel","family":"Koedijk","sequence":"additional","affiliation":[{"name":"Radiotherapeutisch Instituut Friesland, 8934 AD Leeuwarden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"IJzermans","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus MC University Medical Center, 3015 CN Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandra","family":"M\u00e9ndez Romero","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, Erasmus MC Cancer Institute, 3015 CN Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/j.clon.2014.05.016","article-title":"The Role of Radiotherapy and Chemoradiation in the Management of Primary Liver Tumours","volume":"26","author":"Aitken","year":"2014","journal-title":"Clin. 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