fig1

Figure 1. Case example of a patient with recurrent multifocal iCCA treated with PBT. A 67-yr-old woman initially diagnosed with iCCA was treated with neoadjuvant chemotherapy followed by right hepatic lobectomy, postoperative SBRT to 45 Gy in 5 fractions for close margins (A); and adjuvant chemotherapy. She developed oligometastatic disease and was treated with multiple lines of systemic treatment, with the most recent being ivosidenib. She eventually developed solitary progression in the liver with multifocal intrahepatic recurrence and was treated with salvage PBT with PBS (B); Due to the close proximity of the tumors to nearby GI organs, a simultaneous-integrated boost technique was utilized to safely treat the tumors to 37.5-60 GyE in 15 fractions. She remains disease-progression-free two years after completion of PBT (C).