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We performed a systematic review on radiofrequency (RFA), microwave (MWA), irreversible electroporation (IRE), trans\u2010arterial chemoembolization (TACE) and selective internal radiation therapy (SIRT) in CCA. Thirty\u2010one ablation studies (1526 patients), 21 TACE studies (1594 patients), and 38 SIRT studies (1954 patients) were included; most cohorts involved intrahepatic CCA (iCCA) and originated from Asia. For RFA\/MWA, overall survival (OS) typically exceeded 25\u2009months and recurrence\u2010free survival (RFS) 7\u20139\u2009months. The ideal candidate profile for percutaneous ablation was an uninodular iCCA measuring \u2264\u20092\u20133\u2009cm developed on cirrhosis. For TACE, median objective response rate (ORR) was 35%, with median OS 11.7\u2009months and RFS of 4\u2009months. Hypervascularity, low tumour burden (&lt;\u200930%\u201350% of liver involvement), and preserved liver function were associated with better outcomes and may be used to identify suitable candidates for TACE in case of unresectable iCCA. For SIRT, median ORR was 36.3%, OS 14.5\u2009months, and RFS 8.7\u2009months. A large unilobar tumour with personalised dosimetry appears the best candidate for SIRT in unresectable iCCA, with potential for downstaging to surgery in some cases. However, the literature regarding locoregional treatment is predominantly retrospective and heterogeneous, with inconsistent reporting of staging, cirrhosis, and endpoints, and almost no randomised trials. Locoregional radiological therapies remain viable options for carefully selected, liver\u2010dominant iCCA, but prospective multicenter studies are needed to define indications, and to optimise sequencing and combination strategy with systemic treatments.<\/jats:p>","DOI":"10.1111\/liv.70585","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T06:41:18Z","timestamp":1773038478000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Radiological Loco\u2010Regional Treatments for Cholangiocarcinoma: A Systematic Review of the Literature"],"prefix":"10.1111","volume":"46","author":[{"given":"Dimitrios","family":"Pallas","sequence":"first","affiliation":[{"name":"Service D'h\u00e9patologie, AP\u2010HP, Avicenne  Bobigny 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