Hilar cholangiocarcinoma (HCCA) is an aggressive malignancy with a dismal prognosis. The 5-year survival rate has been reported to range from 39% to 50% if an R0 resection is obtained [1] . Approximately 25% patients with early stage HCCA of all cases can be treated with radical surgical resection [2] , while most patients do not have a chance to receive a surgical procedure due to the advanced stage at the time of diagnosis. The poor prognosis is generally attributed to peri–operative mortality, high rates of local tumor recurrence and an insensitive response to systemic treatment. HCCA is traditionally considered to show an unsustained response to chemotherapy. Application of radiotherapy is limited as the special location of tumor would easily lead to severe liver damage. Among unresectable patients, the introduction of catheter-based brachytherapy has showed favorable results, yet, no prospective randomized controlled trial has evealed the survival benefit of local therapy. Presently, liver transplantation has been applied in an attempt to attain a better prognosis for patients with intrahepatic metastases, especially those who have lost the chance to receive a radical resection.