Multimodality Management of Localized Biliary Cancer

Biliary tract cancers (BTCs) are a diverse group of malignancies arising from the biliary tree, including cholangiocarcinoma and gallbladder carcinoma. Patients that are candidates for surgical resection should also have lymphadenectomy. Since recurrence rates are high, after surgical resection, patients should be considered for adjuvant therapy in a multidiscipline setting. The limited availability of randomized clinical trial data makes the optimal treatment option unclear; however, chemotherapy or chemoradiation has been shown to have benefits especially in patients with R1 or R2 resections or lymph node involvement. Patients with unresectable disease should be considered for neoadjuvant therapy with chemotherapy or chemoradiation. Patients that are unable to tolerate chemotherapy should also be considered for locoregional therapies. Clinical trial enrollment is strongly recommended for all patients. Trials involving targeted or immunotherapy are currently ongoing in patients with advanced disease.