 Recently for the first time an improvement of overall survival has been demonstrated in a large randomized phase III trial with chemotherapy combination of cisplatin and gemcitabine n206 compared to gemcitabine mono-chemotherapy n204 Valle et al. 2009. Median overall survival was 8,2 month in the monotherapy arm versus 11,7 month in the combination arm p0.002. As a consequence of this study the combination of Cisplatin 25mgm2 d1,8 and Gemcitabine 1000mgm2 d1,8 should be considered as the standard first line chemotherapy for patients with irresectable cholangio- or gallbladder carcinomas. 