膽管癌是一個存活預後不好的全世界性腫瘤，與全世界 10-15% 的盛行率相比，台灣 2012 年癌症報告指出，膽管癌在所有的肝膽癌症中所佔比率約有 7.5%。而在其他研究報告中，五年 的整體存活率約為 20-30%。如果病患能夠開刀的話，主要的治療方式就是手術。對大部份的 病人來說，因為複雜的大小血管分佈還有旁邊的重要器官影響，很難達到完全切除，因此，術 中或是術後的輔助性治療的角色對癌症治癒就更加重要。在肝外膽管癌的治療文獻中，已使用 手術中放射線治療來減少其他更侵入性治療的劑量、減少副作用以增加局部控制及存活率。我 們提出一個 78 歲的男性肝外膽管癌的病患的病例。這個病患在手術中腫瘤切除後使用 20 Gy 的 手術內放射線治療，並且之後並沒有進一步的化學治療和體外放射治療，在追蹤6 個月之後並 無明顯副作用或腫瘤復發情形。手術中放射線治療，對可以手術並且無局部淋巴轉移的肝外膽 管癌病人，也許是安全且合適的治療，同時需長期追蹤晚期副作用和治療結果。

Cholangiocarcinoma is a malignant neoplasm with a poor survival worldwide. In the 2012 cancer registration report showed a prevalence rate about 7.5% of all hepatobiliary malignancy in Taiwan whereas it was 10 - 15% in the world. The overall 5-year survival rate is only 20 - 30% in literature. Surgical resection is the mainstay treatment for operable patients. However, complete microscopic (R0) resection is difficult to achieve due to the complicated distribution of vessel network and close surrounding normal organs. Thus, the role of post-operative adjuvant radiotherapy is important but normal tissue radiation tolerance remains a critical issue. By using intraoperative radiaotherapy (IORT), the target lesion could be irradiated with single high-dose fraction while avoiding surrounding tissues. Here, we presented a 78-year-old male with extrahepatic cholangiocarcinoma without regional lymphadenopathy. IORT with 20 Gy via a portable kilovoltage x-ray generator was delivered in operative room after removal of tumor and surrounding tissues. The pathology report showed close surgical margin and no regional lymph node metastasis. No further adjuvant external beam radiotherapy or chemotherapy was given due to none of major risk factor and old age. After 6-month follow up, no evidence of recurrence and complication was noted. We conclude that IORT might be a safe radiotherapy modality for patients with resectable extrahepatic cholangiocarcinoma. The long term follow up for evaluation of late toxicity and treatment outcome is warranted.