The following list of treatment options for biliary tract cancer includes the following:

• Surgery
• Adjuvant treatments
• Systemic treatments
• Single-agent approaches

Surgical resection

• Because surgery is the sole treatment option for biliary tract malignancies, care teams with specialised knowledge should determine whether the disease is surgically resectable.
• The absence of all of the following criteria, including extrahepatic adjacent organ invasion, disseminated disease, invasion of the portal vein or main hepatic artery, retropancreatic and paraceliac nodal metastases, or distant liver metastases, is required for resectability. However, some centres may offer vascular reconstruction.
• Depending on the location of the tumour, surgical resection typically entails cholecystectomy, en bloc hepatic resection, and lymphadenectomy with or without bile duct excision.
• Delayed open laparotomy is appropriate if cancer is discovered inadvertently during surgery for unrelated reasons, resectability is not clearly proven, or if the surgeon is untrained in the procedure. This is because there is no survival disadvantage when compared to prompt resection.

Neoadjuvant therapy

• For patients with biliary tract cancer, neoadjuvant chemoradiotherapy is not currently a common treatment option. Nine out of 91 patients who presented with more advanced illness got chemoradiotherapy in a small, carefully chosen case series, and they all achieved a R0 resection. However, a subsequent research looking at chemoradiotherapy with 5-FU failed to find a survival benefit.
• Kobayashi et al. performed a retrospective analysis and found that chemoradiation therapy, which consisted of three cycles of full-dose gemcitabine plus 50–60 Gy radiation, increased both recurrence-free survival and overall survival (P = 0.0263, P = 0.00187). Compared to 79 individuals treated without neoadjuvant therapy, 27 patients who received neoadjuvant chemoradiation therapy experienced a 3-year recurrence-free rate of 78%.
• High-dose neoadjuvant radiation with chemosensitization, followed by liver transplantation, produces excellent results for patients with early-stage, unresectable hilar cholangiocarcinoma or cholangiocarcinoma occurring in the context of primary sclerosing cholangitis

Following is the Mayo Clinic protocol:

• External beam radiation therapy followed by ongoing 5-FU for three weeks
• Two weeks of brachytherapy, followed by
• Capecitabine (kept perioperatively during staging) till transplantation, then
• Exploration of the abdomen for staging
• Transplanting the liver

Adjuvant therapy following curative-intent resection

Stage IB-III (T1-3, N0-1, M0):

• According to Spanish Society of Medical Oncology (SEOM) recommendations, adjuvant capecitabine medication should be given to all patients who have had curative resection of biliary tract cancer for a period of six months.
• In addition to encouraging clinical trial participation, the National Comprehensive Cancer Network (NCCN) guidelines state that only a small amount of clinical trial data are currently available to define a standard regimen or definite benefit. However, they do offer the options of fluoropyrimidine- or gemcitabine-based chemotherapy followed by fluoropyrimidine- or gemcitabine-based chemoradiation or fluoropyrimidine-based chemoradiation, which may be followed by fluoropyrimidine- or
• High rates of local failure following surgery lead to recommendations for radiation therapy in the adjuvant setting. A retrospective analysis of patients who received adjuvant radiotherapy reveals an initial survival benefit, but a longer-term follow-up series suggests that this benefit may be lost after more than 5 years.

Adjuvant chemoradiotherapy regimens for stage IB-III:

• 5-FU 225 mg/m2 IV every day while receiving radiation,
• 5-FU 500 mg/m2 IV bolus administered during radiotherapy on days 1-3 and 29–31;
• During radiation, capecitabine 825 mg/m2 PO twice daily; after radiation, consider a further 4 months of therapy;
• Capecitabine 1000 mg/m2 PO once every 14 days, or
• On radiation-days, capecitabine 800-900 mg/m2 PO BID
• If you have several positive lymph nodes or aggressive or high-risk illness (positive margins), you might want to switch to a gemcitabine-based treatment.

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