The majority of patients with biliary tract cancer develop local recurrence and/or metastases, and treatment of these patients is therefore an important issue. At the time of diagnosis, more than two-thirds of biliary tract cancer patients have irresectable disease [1]. Even patients with an operable tumor have a high rate of recurrence, with a 5-year median survival rate of 9–18% for proximal biliary lesions and 20–30% for more distal tumors [2]. Adjuvant post-operative chemotherapy has not been shown to be useful for biliary tract cancer. In one study, the benefit of adjuvant chemotherapy was seen in gall bladder cancer only [3, 4].

Chemotherapy has been used in an attempt to control disease, and improve survival and quality of life in patients with irresectable, recurrent and metastastic cholangiocarcinoma. Various chemotherapeutic agents, either alone or in combination, have been tested. Most of these studies incorporated both intra-and extra-hepatic cholangiocarcinoma, gallbladder cancer and pancreatic cancer. Although one of these studies demonstrated an improvement in quality of life for patients treated with chemotherapy compared with best supportive care, the median survival remained low (6 versus 2.5 months)[5].