Treatment of Intrahepatic Cholangiocarcinoma-A Multidisciplinary Approach

Abstract

Intrahepatic cholangiocarcinoma (iCC) is distinguished as an entity from perihilar and distal cholangiocarcinoma and gallbladder carcinoma. Recently, molecular profiling and histopathological features have allowed further classification. Due to the frequent delay in diagnosis, the prognosis for iCC remains poor despite major technical advances and multimodal therapeutic approaches. Liver resection represents the therapeutic backbone and only curative treatment option, with the functional residual capacity of the liver and oncologic radicality being deciding factors for postoperative and long-term oncological outcome. Furthermore, in selected cases and depending on national guidelines, liver transplantation may be a therapeutic option. Given the often advanced tumor stage at diagnosis or the potential for postoperative recurrence, locoregional therapies have become increasingly important. These strategies range from radiofrequency ablation to transarterial chemoembolization to selective internal radiation therapy and can be used in combination with liver resection. In addition, adjuvant and neoadjuvant chemotherapies as well as targeted therapies and immunotherapies based on molecular profiles can be applied. This review discusses multimodal treatment strategies for iCC and their differential use.

Keywords: bile ducts; carcinoma; chemoembolization; functional residual capacity; hepatectomy; hepatocellular; immunotherapy; intrahepatic cholangiocarcinoma; liver neoplasms; liver resection; liver transplantation; multimodal; neoadjuvant therapy; prognosis; radiofrequency ablation; therapeutic cholangiocarcinoma.

Figure 1

Schematic presentation of staging and management of intrahepatic cholangiocarcinoma.

Figure 2

Therapy algorithm of intrahepatic cholangiocarcinoma.