This study from Japan reported clinical outcomes of 15 patients with hepatocellular carcinoma with bile duct invasion (BDIHCC) treated with PBT. The median follow-up time was 23.4 months. The 1-, 2-, and 3-year OS rates were 80.0%, 58.7% and 40.2%, respectively, and the corresponding LC and PFS rates were 93.3%, 93.3%, and 74.7% and 72.7%, 9.7%, and 0.0%, respectively. Acute grade 3 cholangitis occurred in 1 patient. No grade 4 or higher acute toxicity. Late grade 3 gastric hemorrhage occurred in 1 patient and pleural effusion in 1 patient. No toxicities of grade 4 or higher were observed. The authors concluded that PBT achieved relatively favorable survival rates without severe toxicities or biliary adverse events, therefore, radical PBT is a viable treatment for patients with BDIHCC.