Abstract
Cholangiocarcinoma (CCA) is a malignancy arising from biliary epithelial cells and
is subdivided based on the location within the biliary tree. The treatment of CCA
differs based on the anatomical involvement within the biliary tree. Perihilar CCA
(pCCA) arises between the cystic duct and the secondary branches of the right and
left hepatic ducts. Surgical resection and liver transplantation offer the only hope
for cure in pCCA, but, unfortunately, more than 80% of patients are considered surgically
unresectable at the time of diagnosis resulting in a limited overall life expectancy
of less than 1 year. For patients with surgically unresectable pCCA, treatment options
are limited and include chemotherapy/chemoradiotherapy and biliary drainage via endoscopic
stenting or percutaneous drainage with minimal overall survival benefits. However,
endobiliary ablation options like photodynamic therapy (PDT), radiofrequency ablation
(RFA), and, to a lesser degree, intraluminal brachytherapy have shown improvements
in overall survival and improvements in stent patency and now should be considered
for all cases of surgically unresectable pCCA. In fact, the 2023 American College
of Gastroenterology (ACG) Clinical Guidelines on the diagnosis and management of biliary
strictures recommend endobiliary ablation (PDT or RFA) for patients with surgically
unresectable pCCA rather than stenting alone.
Keywords
cholangiocarcinoma - endobiliary ablation - radiofrequency ablation - photodynamic
therapy - brachytherapy
