HCCANANO-HOPE1: IRE After Chemotherapy for Locally Advanced Unresectable Perihilar Cholangiocarcinoma

Irreversible electroporation is a non‐thermal ablative technology that uses high‐voltageelectric pulses to create permanent nanopores in tumor cell membranes, leading toapoptosis or other forms of cell death. Because the mechanism is primarily non‐thermal,IRE may better preserve extracellular matrix, bile ducts, vessels, and other criticalstructures than thermal ablation, which is relevant for tumors adjacent to major vascularor biliary anatomy.The main anticipated clinical value of IRE in these protocols is local disease controland potential survival benefit when used after induction therapy in patients withnon‐progressive disease. The procedure may be performed by open or percutaneous accessaccording to tumor location, safety considerations, and institutional expertise.Perioperative management, imaging guidance, and post‐procedure monitoring will followinstitutional standards.Post‐IRE gastrointestinal dysfunction may occur. Symptom‐directed supportive care,including electroacupuncture where appropriate and approved by the investigator, may beused as supportive management. Such care is not intended to replace oncologic treatmentand will be recorded as concomitant treatment when administered.