La radiologia medica

, Volume 121, Issue 9, pp 735–743 | Cite as

Radiotherapy in the multidisciplinary treatment of liver cancer: a survey on behalf of the Italian Association of Radiation Oncology

  • Francesco DionisiEmail author
  • Alessia Guarneri
  • Veronica Dell’Acqua
  • Mariacristina Leonardi
  • Rita Niespolo
  • Gabriella Macchia
  • Tiziana Comito
  • Maurizio Amichetti
  • Pierfrancesco Franco
  • Savino Cilla
  • Luciana Caravatta
  • Filippo Alongi
  • Giovanna Mantello



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.

Materials and 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.


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.


HCC Liver metastases Radiotherapy SBRT 



We thank the AIRO and the AIRO GI Board for the support in the survey preparation and data collection.

Compliance with Ethical Standards


No funds were used in the article preparation.

Conflict of interest

The authors declare no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.


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Copyright information

© Italian Society of Medical Radiology 2016

Authors and Affiliations

  • Francesco Dionisi
    • 1
    Email author
  • Alessia Guarneri
    • 2
  • Veronica Dell’Acqua
    • 3
  • Mariacristina Leonardi
    • 3
  • Rita Niespolo
    • 4
  • Gabriella Macchia
    • 6
  • Tiziana Comito
    • 5
  • Maurizio Amichetti
    • 1
  • Pierfrancesco Franco
    • 2
  • Savino Cilla
    • 7
  • Luciana Caravatta
    • 8
  • Filippo Alongi
    • 9
  • Giovanna Mantello
    • 10
  1. 1.Proton Therapy Unit, Department of OncologyAzienda Provinciale per i Servizi Sanitari, APSSTrentoItaly
  2. 2.Department of Oncology, Radiation OncologyUniversity of TorinoTurinItaly
  3. 3.Division of Radiation OncologyEuropean Institute of OncologyMilanItaly
  4. 4.Department of Radiation OncologySan Gerardo Hospital-University of Milan-BicoccaMonzaItaly
  5. 5.Radiation Oncology DepartmentHumanitas Clinical and Research Center, Italy Cancer CenterRozzanoItaly
  6. 6.Radiation Oncology Unit, Research and Care Foundation ‘Giovanni Paolo II’Catholic University of Sacred HeartCampobassoItaly
  7. 7.Medical Physics Unit, Research and Care Foundation ‘Giovanni Paolo II’Catholic University of Sacred HeartCampobassoItaly
  8. 8.Radiation Oncology Department“San Francesco” HospitalNuoroItaly
  9. 9.Radiation OncologySacro Cuore-Don Calabria HospitalNegrar-VeronaItaly
  10. 10.Department of Oncology and RadiotherapyAzienda Ospedaliero Universitaria Ospedali RiunitiAnconaItaly

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