Expediting care for hepatocellular carcinoma ≤ 3 cm by streamlining radiation segmentectomy: A quality improvement project

Radiation segmentectomy (RS) for early-stage hepatocellular carcinoma (HCC) is routinely performed in two sessions. A process improvement analysis at a single destination medical center demonstrated a prolonged RS time to treatment in early-stage HCC. In response, a multidisciplinary quality improvement project to optimize RS treatment expediency was initiated. The selected strategy was the introduction of single-session RS without Technetium-99m-labeled macroaggregated albumin (MAA) for patients with solitary HCC ≤ 3 cm, based on multi-institutional evidence supporting the safety of eliminating MAA due to a low lung shunt fraction in this population. This patient-centered quality initiative aimed to reduce time from consult to treatment, with total fluoroscopy peak skin dose serving as a measurable safety metric. Participants (n=9) were prospectively screened from 09/2022-10/2023. To measure the effect of the intervention, a matched control cohort (n=24) of patients treated with RS in 2021 was gathered retrospectively. Median time from consult to treatment was 14 days (IQR: 12, 15) in the intervention cohort vs 47 days (IQR: 31, 64) in the control cohort (P<0.001). Estimated lung dose was similar between the intervention and control cohorts (median 2.7 and 2.2 Gy; P=0.32). Total fluoroscopy peak skin dose was 1.4 Gy (IQR: 0.9, 1.6) in the intervention and 2.1 Gy (IQR: 1.3, 3.1) in the control cohort (P=0.06). These results support that streamlining RS can safely expedite cancer care.