*Purpose: Locally advanced intrahepatic cholangiocarcinoma (LAiCCA) has a traditionally poor prognosis with few curative surgical options and a high incidence of postop recurrence. The intent of this pilot study was to assess the safety of neoadjuvant Gem/Cis followed by Yttrium-90 transarterial radioembolization (TARE)/ concurrent Capecitabine and to determine the subsequent R0 resection rate.

*Methods: 5 patients presented 2017-2019 with biopsy proven LAiCCA. A personalized treatment plan was developed for each congruent with our schemata (Figure 1) including Gem/Cis followed by disease specific administration of intrahepatic Y 90 radioembolization with concomitant capecitabine prior to restaging and surgery. Operative planning was designed with intent for RO resection.

*Results: Clinical/ surgical data Table 1. Y-90administration was personalized to optimize surgical options. Segmental dosing was used for tumoral control and in cases of macrovascular invasion to potentiate RO resection(patient 1,4,5) while lobar dosing was used to increase FLR. Hybrid dosing combined both approaches(patient 1,2,3,4). Surgical planning was personalized for each individual case: Extended right trisegmentectomy (patient 1,2,3) extended left triseg (patient 5) and ex vivo right triseg with IVC replacement/L hepatic vein reconstruction (patient 4) (IVC involvement at time of presentation). Tumor viability and degree of differentiation differed among the patients but all achieved R0 resection. Patient 1-3 are NED at most recent follow up.

*Conclusions: The objective in this pilot study was to evaluate the safety and potential efficacy of a MD approach to additive chemotherapy, locoregional intrahepatic radioembolization and curative intent surgery to optimize long term outcomes. The promising preliminary results of this MD approach suggest this may be a novel and innovative approach offering improved long term response for patients with LAiCCA. Further evaluation of 2-year overall survival, 2-year disease-free survivaland assessment of patterns of recurrence (distant, locoregional, both) and salvage therapy options (possible transplant) are included in ongoing studies.

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