My mom recently diagnosed as unresectable metastatic cholangiocarc.

Fatema……I am sorry to hear of your Mom’s diagnoses with Cholangiocarcinoma. This cancer sneaks up on us and frequently does not present symptoms until late stage disease

I agree with Percy in that you should obtain another medical opinion from a center treating a high volume of Cholangiocarcinoma patients. My immediate thought is a center in Italy and I have contacted a physician in order to obtain the name of a specialist in Italy. As soon as I receive a response I will then forward it to you.
Regarding the bone metastases you might want to inquire about Intensity-Modulated Radiation Therapy (IMRT) or Percutaneous Image-guided Cryoablation. Both procedures have shown benefits to members on our site.
I realize how shocking the thought of palliative care comes to you. I believe that most of us have similar feelings, but it is important to remember that palliative care does not exclude possible curative treatments in addition to providing the best quality of life for people facing the pain, symptoms and stresses of a serious illness.

You are a wonderful advocate for your Mom and she must be so very proud of you. And, please remember that people’s responses to treatments vary greatly and don’t give up on hope. Your Mom may show excellent results to the proposed GEMOX chemotherapy. Good luck and please, stay in touch. We care.
All my best wishes,
Marion

Hi,
Based on what your wrote,your mom’ CC have been spread on both lobes and front and back sides of the liver.
I also take a look at your link for SRFA,which is not much different the percutaneous RFA that I had about six months ago except it may be more precise for the location. (ie:they use the same needle-electrodes to burn off the tumors like RFA (see the study list at the bottom of this email.)

I think it is difficult for you mom to have SRFA or RFA based on the multiple extent of the tumors involvement of the liver.

Current NCCN guidelines for metastatic CC included:
Gemcitabine/cisplatin;
Clinical trials at most of the big cancer centers in the US,may be some at Italy and UK.(most of the trials have molecularly targeted agent add to the current 5FU or gemcitabine 1st-line therapy)
5FU based or other gemcitabine based regimen
and finally supportive care in that order.

Your mom is only 57 years old, so the age factor is on her side;make sure she eats well and use Ensure or other protein liquid supplement to increase her energy to fight the cancer.(I took 1-2 bottles/day(about 350-700 calories total in addition to my regular diet;I took multivitamins for adults 1-2 tab/day;I drink at least 6-8 glasses of liquid-about 2000-2400ml/day for hydration and mostly I eat fruits and vegetables,soy beans products like TO-FU ; try to sleep for at least 8hrs starting no later 10pm.)these are things we can do for ourselves.

At this point,I will follow your oncologist recommendation to start the GEMOX treatment and will follow with PET/CT in 2 months to check on the progress.
Currently GEMOX+cetuximab has the highest objective response rate(63%)but the long term outcome such as OS and PFS were not reported.further study of this combination is warrented.
(you can read my messages on the expericnce forum about the PET/CT and chemotherapy as well as the management of the side effects.)
And if you like ,you can always,like others, write to me via emails thru this web site by clicking my email address under my ID PCL1029.
Below are a few of the chemotherapy currently used without the molecularly target agents.
Chemotherapy such as GEMOX; ECF regimen of epirubin+cisplatin+infusional 5FU); GEMCAP(gemzar+capecitabine)Gemcitabine+irinotecan;Oxaliplatin+capecitabine to name a few.

Stereotactic radiofrequency ablation.
Bale R, Widmann G, Haidu M.
Source

Department for Microinvasive Therapy (SIP), Medical University Innsbruck, Anichstr. 35 6020, Innsbruck, Austria.
Abstract
PURPOSE:

To describe the technique of percutaneous stereotactic radiofrequency ablation (SRFA) and its application in a patient with an unresectable multifocal intrahepatic cholangiocarcinoma (ICC).
MATERIALS AND METHODS:

A 72-year-old man presented with two nodules of an ICC with a maximum diameter of 10 and 4 cm, respectively. To produce overlapping ablation areas and cover the entire tumor volume, 18 paths for the placement of radiofrequency ablation (RFA) probes at multiple locations were planned on 2D and 3D reconstructions of the computed tomographic (CT) data. The 15-gauge coaxial needles were advanced through the aiming device to the preplanned depth. A control CT fused to the planning CT data confirmed correct needle placements. RFA was performed with an impedance-based multiple-electrode RFA system. Fusion of the contrast-enhanced control CT with the planning CT showed an appropriate zone of ablation.
RESULTS:

Besides a mild asymptomatic pleural effusion, no complications occurred. Twenty-seven months after the first RFA, two new small distant liver metastases were successfully treated by SRFA. Currently, 38 months after diagnosis and 36 months after the first SRFA, the patient is free of detectable disease.
CONCLUSION:
SRFA seems to offer an effective treatment option in selected patients with even unresectable ICC.
Keep in touch and
God bless.

Hi,
Sorry to hear the news,I am a patient as well for 30 month now. But if you can tell me a bit about more about your mom,I can try to answer your question better.
1. When is the Dx.made?
2. Where is the rumor located? Left,rifght or the caUdate lobe and which segment? Posterior or anterior?
3. How big is/are the rumors? And how many or just one big one?
The above are related to whether your mom can have radiation procedures here in the State such aschemoembo,radioembrolization with Y 90,RFA SBRT etc.
4. How old is your mom? Is she in relatively good health or have other issues?
In the meantime ,I will look up the chemo like GEMOX with molecularly targeted agents combo. I know for sure GEMOX+Avastin,GEMOX+cetuximab and Tarceva and sorafenib had been used together.But most are in clinical trial setting and may be that is why your oncologist hesitated to try.
Most of the time,whenCC have metastasized to other organs,surgeons will not do resection to remove the tumor and systemic chemo is the choice of treatment.
More recently interventional radiation provided an other option to combat this horrible disease.
Please feel free to ask questions, and in the meantime try to relax and concentrate your energy on finding the best treatment options,if available,for your mom.
God bless