Dionisi Francesco, Guarneri Alessia, Dell'Acqua Veronica, Leonardi Mariacristina, Niespolo Rita, Macchia Gabriella, Comito Tiziana, Amichetti Maurizio, Franco Pierfrancesco, Cilla Savino, Caravatta Luciana, Alongi Filippo, Mantello Giovanna
Proton Therapy Unit, Department of Oncology, Azienda Provinciale per i Servizi Sanitari, APSS, Via al desert, 14, 38123, Trento, Italy.
Department of Oncology, Radiation Oncology, University of Torino, Turin, Italy.
Radiol Med. 2016 Sep;121(9):735-43. doi: 10.1007/s11547-016-0650-5. Epub 2016 Jun 2.
To report the results of the first Italian survey investigating the role of liver-directed radiotherapy in the multidisciplinary approach of primary and metastatic liver cancer.
A 21-item, two-section questionnaire was sent to all Italian radiotherapy centers on June 2014. The two sections aimed at: (1) evaluating the presence of a multidisciplinary liver tumor board and describing the role of radiation oncologists within the latter, (2) analyzing Radiotherapy treatment details and differences between centers.
A total of 37 centers completed the survey. A multidisciplinary liver tumor board was available in most centers (73 %), with a radiation oncologist routinely attending the latter in the majority of cases (85 %). Most of the respondents considered liver-directed Radiotherapy as the third line choice when other therapies were not indicated or technically suitable. 18 centers reported the use of liver-directed radiotherapy. The majority of centers started liver irradiation after 2010. The most adopted motion management strategy was abdominal compression. The most adopted GTV-CTV expansion was 0 and 5 mm for metastases and hepatocellular carcinoma, respectively. Stereotactic body radiotherapy was the technique of choice; several treatment schedules were registered, being 45 Gy in three fractions the most reported fractionation scheme. Dose was prescribed at the PTV margin in most cases.
Liver-directed radiotherapy represents a new field of interest which is currently adopted by 10 % of all Italian Centers. The technical equipment seems adequate. The variations observed in the treatment regimens reflect the lack of a well-established standard schedule.
报告意大利首次关于肝脏定向放疗在原发性和转移性肝癌多学科治疗方法中作用的调查结果。
2014年6月向所有意大利放疗中心发送了一份包含21项内容、分两部分的问卷。这两部分旨在：（1）评估多学科肝脏肿瘤委员会的存在情况，并描述放疗肿瘤学家在其中的作用；（2）分析放疗治疗细节及各中心之间的差异。
共有37个中心完成了调查。大多数中心（73%）设有多学科肝脏肿瘤委员会，在大多数情况下（85%）放疗肿瘤学家会定期参加该委员会。大多数受访者认为，当其他治疗方法不适用或在技术上不合适时，肝脏定向放疗是第三线选择。18个中心报告使用了肝脏定向放疗。大多数中心在2010年后开始进行肝脏照射。最常用的运动管理策略是腹部压迫。对于转移瘤和肝细胞癌，最常用的GTV-CTV外放分别为0和5毫米。立体定向体部放疗是首选技术；记录了几种治疗方案，最常报告的分割方案是分三次给予45 Gy。大多数情况下剂量在PTV边缘处处方。
肝脏定向放疗是一个新的关注领域，目前意大利所有中心中有10%采用。技术设备似乎足够。观察到的治疗方案差异反映出缺乏成熟的标准方案。
