Abstract
Simple SummaryCholangiocarcinoma 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.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.
Highlights
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Photodynamic therapy (PDT) is a tumor-specific ablation therapy that is the standard of care for nonresectable cholangiocarcinoma [25]
photodynamic therapy (PDT) is well tolerated with a minimal side effect profile, but patients do stand the risk of cholangitis according to Moole’s 2017 meta-analysis
Summary
Cholangiocarcinoma (CCA) is a biliary malignancy that accounts for 3% of gastrointestinal malignancies and 15% of primary liver cancers [1]. The overall incidence of CCA has increased over recent decades, and the percentage of patients who survive. The highest incidence rates were found among males (13.94 [95% CI, 13.64–14.25]), patients older than 65 years (63.43 [95% CI, 62.21–64.68]), and Asians (17.78 [95% CI, 17.00–18.58]) [6]. This report suggested that the highest risk of mortality was among males (hazard ratio (HR) 12.16 [95% CI 11.866–12.460]), patients older than 65 years For locally advanced CCA in patients who are not LR candidates, neoadjuvant therapies can be used to reduce the tumor burden and allow these patients to eventually be resection or transplantation candidates These neoadjuvant therapies include transarterial chemoembolization (TACE), selective internal radiation therapy (SIRT), radiofrequency ablation (RFA), and photodynamic therapy (PDT), which can control local tumors and avoid systemic treatment side effects.
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