Advances in loco-regional palliation of unresectable cholangiocarcinomas

Cholangiocarcinoma (CC) represents the second most common primary hepatic malignancy after hepatocellular carcinoma, accounting for 10% to 15% of primary liver tumors. Its prognosis is often poor due to its late presentation and its relative resistance to current chemotherapy and radiotherapy regimens. At the time of diagnosis, more than half of the patients are not candidates for surgical therapy due to either invasion of vascular structures or distant metastases. Therefore, for a large proportion of patients, palliation remains the only option for better quality of life and, in some circumstances, longer survival. The main goals of palliative interventions for CC are: restoration of the biliary drainage and resolution of pruritis caused by obstructive jaundice, improvement of the nutritional status and reduction of pain. During the last decades, novel therapies have been introduced to optimize the management of patients with unresectable CC. These therapies can be resource intensive and have some adverse effects; therefore patient selection is crucial. This article discusses the current options for palliation of CC.