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Intrahepatic cholangiocarcinoma (ICC) is a highly fatal disease with limited therapeutic options. The determinants, trends, and outcomes of different therapies for ICC are largely unknown in the United States.Using data from the Surveillance, Epidemiology, and End-Results-(SEER) Medicare database, we compared ICC patients receiving different therapies between 1992 and 1999. Univariate and multivariate analyses were performed and adjusted odds ratios (AORs) were calculated. Hazard ratios were calculated for the survival analysis.Eight hundred sixty-two cases were included. The mean age at diagnosis was 77.9 years (SD=7.1). Only 6.3% received surgical resection, 65.5% received palliative interventions (16.1% surgical, 44.0% endoscopic), 24.4% received only chemo or radiation therapy whereas 3.8% did not receive any treatment. The median survival was 708 days [95% confidence interval (CI): 458-945] for surgical resection, 227 days (95% CI: 182-294) for surgical palliation, and 123 days (95% CI: 108-148) for endoscopic palliation. Patients receiving surgical resection were younger (AOR=5.6, 95% CI: 2.9-11.1), more likely to be diagnosed later in the study period (AOR=2.2, 95% CI: 1.1-4.2), and had better mortality (hazard ratio=0.3, 95% CI: 0.2-0.4). Patients receiving surgical palliation were younger (AOR=1.6, 95% CI: 1.1-2.3), more likely to be diagnosed in the early time period (AOR=1.5, 95% CI: 1.1-2.2), and had similar mortality to those receiving endoscopic palliation.Only a minority of patients with ICC receives potentially curative therapy. Young age is the strongest predictor of receiving potentially curative treatment. Older patients and those diagnosed in recent time periods are more likely to receive endoscopic palliation. Surgical resection was associated with improved survival. There was no difference in survival between surgical and endoscopic palliation.