Locoregional Treatments in Cholangiocarcinoma and Combined Hepatocellular Cholangiocarcinoma

SIMPLE SUMMARY: Cholangiocarcinoma is an aggressive primary cancer of the biliary tree. Combined hepatocellular cholangiocarcinoma is also a primary liver malignancy but displays properties both of cholangiocarcinoma and hepatocellular carcinoma. Liver resection is the mainstay treatment; however, some patients are not surgical candidates. Locoregional therapies have emerged with the goal of providing local cancer treatment and control. We review different locoregional strategies for treating cholangiocarcinoma and combined hepatocellular cholangiocarcinoma. ABSTRACT: Cholangiocarcinoma (CCA) is a primary and aggressive cancer of the biliary tree. Combined hepatocellular cholangiocarcinoma (CHC) is a distinctive primary liver malignancy which has properties of both hepatocytic and cholangiocytic differentiation. CHC appears to have a worse prognosis compared to hepatocellular carcinoma, and similar to that of intrahepatic CCA. While significant advances have been made in understanding the pathophysiology and treatment of these two tumor types, their prognosis remains poor. Currently, liver resection is the primary treatment modality; however, only a minority of patients are eligible for surgery. However, the use of locoregional therapies proves an alternative approach to treating locally advanced disease with the aim of converting to resectability or even transplantation. Locoregional therapies such as transarterial chemoembolization (TACE), selective internal radiation therapy (SIRT), radiofrequency ablation (RFA), and photodynamic therapy (PDT) can provide patients with tumor control and increase the chances of survival. In this review, we appraise the evidence surrounding the use of locoregional therapies in treating patients with CCA and CHC.