Radiation Therapy For Hepatocellular Carcinoma In Russia: A Survey-Based Analysis Of Current Practice And The Impact Of An Educational Workshop On Clinical Expertise

Radiation therapy (RT) is an effective treatment modality for hepatocellular carcinoma (HCC), but globally it is underutilized. In Russia, practice patterns with regard to liver-directed radiation are unknown. Under the auspices of Russian Society of Clinical Oncology (RUSSCO) our team conducted a contouring workshop for Russian radiation oncologists. institutional review board-approved pre- and post-workshop surveys were analyzed to determine baseline clinical experience and patterns of care for liver-directed RT amongst Russian providers. The effect of the contouring workshop on participants’ knowledge was tested using mixed effect model. Forty-two pre-workshop and 24 post-workshop questionnaires were analyzable with a 100% response rate. Sixty-eight percent of respondents had never evaluated a patient with HCC and only 7% (3 out of 42) reported treating an HCC patient with liver-directed RT. Nonetheless, 80% of respondents were comfortable offering liver-directed RT prior to the workshop. After the workshop 85% of respondents felt comfortable treating a patient with HCC with liver-directed RT and 50% were comfortable recommending stereotactic body radiation therapy (SBRT). Advanced motion management techniques commonly used with liver SBRT were not frequently available in most Russian centers, with abdominal compression used by 14%, respiratory gating by 31% and tumor tracking by 10% of respondents. Measures of knowledge pertaining to evaluation of HCC patients and selection for appropriate liver-directed therapies were dramatically improved after the workshop. Liver-directed RT is not commonly used in Russia in the management of patients with HCC, and few centers are equipped for motion management. Our contouring workshop resulted in dramatically improved understanding of the evaluation and management of HCC patients. High comfort level among Russian providers with liver-directed RT in the absence of clinical experience and necessary advanced motion management tools is worrisome. We recommend starting with a more protracted fractionated RT and building experience through attendance of additional educational activities, participation in multidisciplinary liver tumor boards, and prospective analysis of treatment toxicity and outcomes.