<b><i>Background:</i></b> Incidence of cholangiocarcinoma (CCA) in western countries is rising. In the palliative setting, chemotherapy is the only established treatment. The evidence for other treatments including locoregional therapy is low. However, such individual treatments are offered in a real-world setting. The aim of this study is to document the offered treatments and to analyze the survival of patients with unresectable CCA treated at a tertiary referral center. Patients and methods: Data from 220 consecutive patients with CCA treated at a German university cancer center from January 1, 2008, until December 31, 2012. Of those, 105 patients were unresectable. Survival curves were calculated according to the Kaplan-Meier method; log-rank test was applied for survival analysis. <b><i>Results:</i></b> Any palliative treatment was beneficial for patients with unresectable CCA when compared to best supportive care (BSC) alone; median OS with BSC was 10 weeks (BSC vs. transarterial chemoembolization [TACE] <i>p</i> = 0.017, HR 0.36; BSC vs. TACE/chemotherapy <i>p</i> &#x3c; 0.001, HR 0.24; BSC vs. chemotherapy <i>p</i> &#x3c; 0.001, HR 0.31). Combination of TACE and chemotherapy prolonged overall survival as compared to TACE alone (105 vs. 43 weeks, <i>p</i> = 0.045). <b><i>Conclusion:</i></b> Prognosis in advanced stage CCA is still very poor. However, multimodal treatment in palliative patients significantly prolong survival.