Neoadjuvant and adjuvant therapy for cholangiocarcinoma

Cholangiocarcinoma is an epithelial-based malignancy that is often described by its location of origin within the biliary tree. Curative-intent treatment is based upon patient fitness, extent of disease, absence of metastatic disease, and, when liver resection is required, anticipated amount of liver parenchyma remaining. Systemic and regional therapies are often required in the treatment of cholangiocarcinoma and can be employed in a neoadjuvant or adjuvant fashion. While cytotoxic chemotherapy has traditionally been studied in the adjuvant setting, the optimal treatment regimen, role of radiotherapy, and use of targeted therapies remain topics of investigation. Neoadjuvant therapy, traditionally reserved for borderline-resectable or oncologically high-risk disease, continues to be studied in these patients as well as in patients otherwise suited for up-front resection. As with evolving treatment regimens, patient selection and prognostic factors are increasingly studied through use of national and multi-institutional databases to enhance the multidisciplinary approach required for treatment of cholangiocarcinoma.