Advances in the management of cholangiocarcinoma

Table 2 Role of treatment modalities in the management of cholangiocarcinoma

Tumor location	Surgery	Liver transplantation	Systemic therapy			Radiation therapy
			NeoAdjuvant	Adjuvant	Palliative
Intrahepatic	Liver resection is first line management, anatomic resection is preferred	Clinical trials and select centers only	Not indicated	Capecitabine	Gemcitabine/Cisplatin; FOLFOX or evaluate for targetable mutations	External beam radiation reduces recurrence in R1 resection
Perihilar	Liver resection is first line management	Consider if not resection candidate, PSC	Only prior to liver transplant	Capecitabine	Gemcitabine/Cisplatin; FOLFOX	External beam radiation required pre liver transplant
Distal	Pancreaticoduodenectomy is first line management	Not indicated	Not indicated	Capecitabine	Gemcitabine/Cisplatin; FOLFOX	No defined role

PSC: Primary sclerosing cholangitis; FOLFOX: Leucovorin, fluorouracil, and oxaliplatin.