Because of the rare nature of the tumor, there are limited prospective trials addressing the roles for surgery, chemotherapy (CT) and radiation therapy (RT) in the treatment of cholangiocarcinoma. Despite advances in surgical and radiotherapy techniques, the prognosis for cholangiocarcinoma remains dismal. Historically, survival is poor with a 0-10% 5-year survival. In more recent years, a median survival of 2-15 months is expected. Patients who are able to undergo surgical resection at diagnosis have longer survival of approximately 20-24 months. Recent investigations in the area of neoadjuvant chemoradiation followed by orthotopic liver transplant in a select group of patients report promising results, with 1-, 3- and 5-year overall survival of 92%, 82% and 82%, respectively. Although this approach may be appropriate for select patients, namely younger patients with small tumors, no or limited nodal involvement, and no encasement of the major vasculature, the majority of patients presenting with cholangiocarcinoma will present with unresectable disease at initial diagnosis, often due to nodal involvement.