Primary care clinic.

Inclusion Criteria:

1. The diagnosis of cholangiocarcinoma will be established preoperatively by at least one of the following criteria:

   1. A positive brush cytology or biopsy result obtained at the time of cholangiography;
   2. Fluorescence in situ hybridization demonstrating aneuploidy;
   3. A serum CA 19-9 value greater than 100 U/mL in the presence of a radiographically characteristic malignant stricture in the absence of cholangitis.
2. Tumor is above the cystic duct and is unresectable.
3. Patient is a suitable candidate for OLT and judged a good candidate for the study by a radiation oncologist, a medical oncologist, and the liver transplant team.
4. Maximum Eastern Cooperative Oncology Group performance status of 2 and a minimum daily caloric intake of 1200kcal.
5. No evidence of metastatic disease.
6. Between ages 18 - 70.
7. Patient must provide written informed consent.

Exclusion Criteria:

1. Patients with intrahepatic metastasis
2. Patients with uncontrolled infections (sepsis)
3. Patients undergoing prior attempts at resection
4. Prior treatment with either irradiation or chemotherapy for this disease
5. Evidence of extrahepatic disease, including local lymph node metastasis (except peri-hilar nodes).
6. History of another malignancy diagnosed within 5 years, excluding superficial skin and cervical cancers