Locoregional Treatment Options for Locally Advanced Intrahepatic Cholangiocarcinoma

Intrahepatic cholangiocarcinoma (ICC) is an aggressive primary liver malignancy. Although surgical resection remains the standard of care, most patients present with either metastatic or locally advanced, unresectable disease. Although effective systemic therapy is paramount in these situations, locoregional tumor control frequently delays liver-related complications and mortality. To address this challenge, a variety of liver-directed therapies have emerged, including transarterial chemoembolization, transarterial radioembolization with yttrium-90, hepatic arterial infusion chemotherapy, external-beam radiation therapy and in select cases, liver transplantation. These modalities have shown promise in prolonging survival, enhancing local control, and in some instances, downstaging tumors to resectability. This review examines recent advancements in locoregional treatment options for unresectable ICC, highlights their use and associated outcomes, and explores general guidelines for optimal patient selection.