title: Radiotherapy in the multidisciplinary treatment of liver cancer: a survey on behalf of the Italian Association of Radiation Oncology.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Proton Therapy Unit, Department of Oncology, Azienda Provinciale per i Servizi Sanitari, APSS, Via al desert, 14, 38123, Trento, Italy. francesco.dionisi@apss.tn.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Dionisi
authors.affiliation: Department of Oncology, Radiation Oncology, University of Torino, Turin, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Guarneri
authors.affiliation: Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Dell'Acqua
authors.affiliation: Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Mariacristina
authors.initials: M
authors.lastname: Leonardi
authors.affiliation: Department of Radiation Oncology, San Gerardo Hospital-University of Milan-Bicocca, Monza, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Niespolo
authors.affiliation: Radiation Oncology Unit, Research and Care Foundation 'Giovanni Paolo II', Catholic University of Sacred Heart, Campobasso, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Macchia
authors.affiliation: Radiation Oncology Department, Humanitas Clinical and Research Center, Italy Cancer Center, Rozzano, Milan, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Comito
authors.affiliation: Proton Therapy Unit, Department of Oncology, Azienda Provinciale per i Servizi Sanitari, APSS, Via al desert, 14, 38123, Trento, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Amichetti
authors.affiliation: Department of Oncology, Radiation Oncology, University of Torino, Turin, Italy.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Franco
authors.affiliation: Medical Physics Unit, Research and Care Foundation 'Giovanni Paolo II', Catholic University of Sacred Heart, Campobasso, Italy.
authors.forename: Savino
authors.initials: S
authors.lastname: Cilla
authors.affiliation: Radiation Oncology Department, "San Francesco" Hospital, Nuoro, Italy.
authors.forename: Luciana
authors.initials: L
authors.lastname: Caravatta
authors.affiliation: Radiation Oncology, Sacro Cuore-Don Calabria Hospital, Negrar-Verona, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Alongi
authors.affiliation: Department of Oncology and Radiotherapy, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Mantello
mesh_terms: D003131:Combined Modality Therapy; D006801:Humans; D007558:Italy; D008113:Liver Neoplasms / Q000532:radiotherapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D018787:Radiation Oncology / Q000458:organization & administration*; D011795:Surveys and Questionnaires
keywords: HCC; Liver metastases; Radiotherapy; SBRT