Evaluation of Bone Mineral Density in Patients with Type 1 Gaucher Disease in Argentina.

The purpose of this study was to evaluate the frequency of osteoporosis (OP) in patients with Gaucher disease (GD) in Argentina. GD patients from 28 centers were consecutively included from April 2012 to 2014. Bone mineral density (BMD) was determined by dual X-ray absorptiometry in the lumbar spine and the femoral neck or the total proximal femur for patients ≥20 yr of age, and by whole-body scan in the lumbar spine in patients <20 yr of age. In children, mineral density was calculated using the chronological age and Z height. OP diagnosis was determined following adult and pediatric official position of the International Society for Clinical Densitometry. A total of 116 patients were included, of which 62 (53.5%) were women. The median age was 25.8 yr. All patients received enzyme replacement therapy, with a median time of 9.4 yr. Normal BMD was found in 89 patients (76.7%), whereas low bone mass (LBM) or osteopenia was found in 15 patients (13%) and OP in 12 patients (10.3%). The analysis of the pediatric population revealed that 4 patients (9.3%) had LBM and 3 (7%) had OP (Z-score ≤ -2 + fractures height-adjusted by Z), whereas in the adult population (n = 73), 11 patients (15%) had LBM or osteopenia and 9 (12.3%) had OP. Bone marrow infiltration and the presence of fractures were significantly correlated with the presence of OP (p = 0.04 and <0.001, respectively). This is the first study in Argentina and in the region describing the frequency of OP or LBM in GD patients treated with imiglucerase using the official position of the International Society for Clinical Densitometry.

Frequency of surgery and hospital admissions for communicable diseases in a high- and middle-income setting.

BACKGROUND: In high-income countries, non-communicable diseases drive the demand for surgical healthcare. Middle-income countries face a double disease burden, of both communicable and non-communicable disease. The aim of this study was to describe the role of surgery for the in-hospital care of infectious conditions in the high-income country Sweden and the middle-income country South Africa. METHODS: A retrospective cohort study was performed of 1.4 million infectious disease admissions. The study populations were the entire population of Sweden, and a cohort of 3.5 million South Africans with private healthcare insurance, during a 7-year interval. The outcome measures were frequency of surgical procedures across a spectrum of diseases, and sex and age during the medical care event. RESULTS: Some 8.1 per cent of Swedish and 15.7 per cent of South African hospital admissions were because of infectious disease. The proportion of infectious disease admissions that were associated with surgery was constant over time: 8.0 (95 per cent c.i. 7.9 to 8.1) per cent in Sweden and 21.1 (21.0 to 21.2) per cent in South Africa. The frequency of surgery was 2.6 (2.6 to 2.7) times greater in South Africa, and 2.2 (2.2 to 2.3) times higher after standardization for age, sex and disease category. CONCLUSION: The study suggests that surgical care is required to manage patients with communicable diseases, even in high-income settings with efficient prevention and functional primary care. These results further stress the importance of scaling up functional surgical health systems in low- and middle-income countries, where the disease burden is distinguished by infectious disease.

Adjuvant radiotherapy for extremity and trunk wall atypical lipomatous tumor/well-differentiated LPS (ALT/WD-LPS): a French Sarcoma Group (GSF-GETO) study.

BACKGROUND: The role of adjuvant radiotherapy (RT) in the management of atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WD-LPS) remains controversial. METHODS: Two hundred eighty-three patients with operable ALT/WD-LPS, no history of previous cancer, chemotherapy (CT) or RT, treated between 1984 and 2011 registered in the Conticabase database were included and described. Overall (OS), progression-free survival (PFS) and time to local relapse (TTLR) were evaluated from the time of first treatment. RESULTS: Three of 20 centers enrolled 58% of the patients. Median age at diagnosis was 61 (range 25-94) years, 147 patients (52%) were males, 222 (78%) patients had their primary tumor located in an extremity while 36 (13%) and 25 (9%) had tumors involving the girdle and the trunk wall, respectively. The median size of primary tumors was 17 cm (range 2-48 cm). Adjuvant RT was given to 132 patients (47%). Patients who received adjuvant RT had larger tumors (P = 0.005), involving more often the distal limbs (P < 0.001). Use of adjuvant RT varied across centers and along the study period. Other characteristics were balanced between the two groups. Median follow-up was 61.7 months. None of the patients developed metastasis during follow-up. The 5-year local relapse-free survival rates were 98.3% versus 80.3% with and without adjuvant RT, respectively (P < 0.001). Once stratified on time period (before/after 2003), adjuvant RT, tumor site and margin status (R0 versus other) were independently associated with TTLR. No OS difference was observed (P = 0.105). CONCLUSION: In this study, adjuvant RT following resection of ALT/WD-LPS was associated with a reduction of LR risk.

Adherence to consensus-based diagnosis and treatment guidelines in adult soft-tissue sarcoma patients: a French prospective population-based study.

BACKGROUND: Soft-tissue sarcomas (STSs) are rare tumors with varied histological presentations. Management and treatment are thus complex, but crucial for patient outcomes. We assess adherence to adult STS management guidelines across two French regions (10% of the French population). We also report standardized incidence. PATIENTS AND METHODS: STS patients diagnosed from 1 November 2006 to 31 December 2007 were identified from pathology reports, medical hospital records, and cancer registries. Guideline adherence was assessed by 23 criteria (validated by Delphi consensus method), and age and sex-standardized incidence rates estimated. Associations between patient, treatment, and institutional factors and adherence with three major composite criteria relating to diagnostic imaging and biopsy as well as multidisciplinary team (MDT) case-review are reported. RESULTS: Two hundred and seventy-four patients were included (57.7% male, mean age 60.8 years). Practices were relatively compliant overall, with over 70% adherence for 10 criteria. Three criteria with perfect Delphi consensus had low adherence: receiving histological diagnosis before surgery, adequacy of histological diagnosis (adherence around 50% for both), and MDT discussion before surgery (adherence <30%). Treatment outside of specialized centers was associated with lower adherence for all three composite criteria, and specific tumor sites and/or features were associated with lower adherence for diagnostic imaging, methods, and MDT meetings. STS standardized incidence rates were 4.09 (European population) and 3.33 (World) /100 000 inhabitants. CONCLUSIONS: Initial STS diagnosis and treatment across all stages (imaging, biopsy, and MDT meetings) need improving, particularly outside specialized centers. Educational interventions to increase surgeon's sarcoma awareness and knowledge and to raise patients' awareness of the importance of seeking expert care are necessary.

Clinical outcome of leiomyosarcomas of vascular origin: comparison with leiomyosarcomas of other origin.

BACKGROUND: There are no data about the natural history of leiomyosarcoma of vascular origin (vLMS) in comparison with leiomyosarcoma (LMS) of other origin and about the management of advanced disease. METHODS: Among 1472 patients diagnosed with sarcoma from January 1980 to December 2008 at our institution, 195 patients (13%) had LMS. LMS had a vascular origin in 14 cases (7%). RESULTS: Patients with vLMS had a significantly worse median metastasis-free survival (MFS) (0.25 versus 9.6 years, P = 0.001) and overall survival (OS; 2.1 versus 7 years, P < 0.0001) than patients with LMS of other origin. On multivariate analysis, grade and vascular origin were the sole independent adverse prognostic factors for OS. Eight metastatic patients with vLMS received a first-line anthracycline chemotherapy regimen. Two patients had partial response, four had stable disease and two had progressive disease. OS of patients with metastatic vLMS was not significantly different from that observed in patients with metastatic LMS of other origin (22.1 versus 16.5 months, P = 0.84). CONCLUSIONS: Vascular origin is an independent adverse prognostic factor for MFS and OS in patients with LMS. Patients with metastatic vLMS had a similar outcome than patients with metastatic LMS of other origin.

[Noninvasive optical laser technologies for the transplantation of mammalian nuclei].

The results of pioneering studies on the development of radically new noninvasive methods for the transplantation of mammalian somatic cell nuclei with the use of optical laser manipulations are presented, and their comparison with traditional invasive methods is performed. It is shown that all the key steps, including the enucleation of a recipient cell, the transfer of a somatic cell (karyoplast), its bringing close together with the recipient cytoplast, and the fusion of the cytoplast with the somatic cell, can be effectively conducted using the laser only with the complete replacement by laser of traditional mechanical micromanipulators and other devices, including devices for electrofusion. The results indicate the unique potentialities of laser and the prospects of its application in modern cell engineering in a wide spectrum of studies on oocytes and early mammalian embryos, in particular in technologies of therapeutic and reproductive cloning.

Do electronic patient information systems improve efficiency and quality of care? An evaluation of utilisation of the Discovery HealthID application.

BACKGROUND: Electronic health records (EHRs) appear to offer a number of potential benefits, but practitioners are often hesitant to make the transition to using them. OBJECTIVES: To determine whether the use of one such system, designed and offered by a health insurer (HealthID; Discovery Health), makes a difference to the efficiency and quality of doctor-patient consultations. METHODS: A descriptive study using mixed methods was designed. A qualitative phase of individual interviews of purposefully sampled respondents was followed by a quantitative survey of a random sample of general practitioners and specialists who were registered users of the system. RESULTS: In the qualitative findings, 18 respondents reported their perceptions of the ease of use of the application, their motivation for using it, its functions and benefits, the impact on efficiency and quality of care, and the challenges they experienced. In addition, they reported on the details of the challenges of using the system, and made suggestions for improvements, particularly with regard to the need for training and IT support. The quantitative results from the majority of 93 respondents confirmed that while the use of the app improved patient care through positive effects on specific functions such as access to accurate patient records and easier Chronic Illness Benefit applications, they felt that it had an equivocal impact in other areas, such as maintaining patient confidentiality and enhancing teamwork and efficiency. The financial incentives offered by Discovery Health, as well as possibly the training and support provided, appear to be more influential for high-frequency than for low-frequency users. The majority said that it did not help with referrals or script writing, or with access to International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) codes. CONCLUSIONS: EHR systems like Discovery Health's HealthID could improve the efficiency of medical consultations by increasing access to stored health information without requiring data entry by clinicians, and thereby have the potential to indirectly improve the quality of care, provided that certain conditions are met.

[Demography of radiation oncology residents in France in 2008: current situation and perspectives for the next three years]. / Démographie des internes en oncologie-radiothérapie en France en 2008: état et perspectives pour les trois prochaines années.

PURPOSE: Although a recent increase in number of young radiation oncologists in training has been observed during the past decade, the general demographic evolution of radiation oncologists covers partially future needs. MATERIAL AND METHOD: During the seven past national annual courses, which were organised and supported by the Société française des jeunes radiothérapeutes oncologues (SFJRO), the Société française de radiothérapie oncologique (SFRO), the Collège national des enseignants de cancérologie (CNEC) and the Institut national du cancer (Inca), different types of surveys were realized in order to analyse demography, quality of training and motivations of French residents in radiation oncology. The latest results were collected during the last national course, which took place in March 2008. Seventy-five young French radiation oncologists ("internes des hopitaux" or residents) out of 110 participants who attended the national course and 75 questionnaires were analysed. RESULTS: Since 2002, the total number of residents increased regularly (50, 75, 103 and 109 residents respectively in 2000, 2005, 2007 and 2008). Men and women are presently 48.5% and 51.5% respectively. Qualitative analysis of practical and theoretical training was performed using a visual analogical scale from zero to 10. Scores of 56 and 61 were respectively observed. Other descriptions of local training in the different universities (clinical skills, clinical cases analysis, bibliography session...) are described. Finally, analysis of the motivations for choosing the radiation oncology speciality demonstrates common interests in both medical practice and technical aspects in oncology. Innovation, technology, imaging and research are also widely mentioned. Sixteen residents will finish their training by the end of 2008, 42 are expected in 2009 and 27 in 2010. Almost all residents believe that a postgraduate position is necessary to complete their training as assistant professor ("chefs de clinique-assistants des hôpitaux") in a university hospital or a cancer centre. Unfortunately, only 36 assistant professor positions are available in France, representing half of the need. Only 21 residents out of 104 already have a position as assistant professor. The availability of such a position remains undetermined for the rest of them. CONCLUSIONS: Despite the recent increase in the number of residents in radiation oncology in France, the need to create new assistant professor positions is crucial to assure quality of training for this both medical and technical speciality. Since 2002, the establishment of SFJRO has facilitated national links among residents, between residents and professors (CNEC), and between the French society (SFRO) and the European society (ESTRO).

Geant4 physics list comparison for the simulation of phase-contrast mammography (XPulse project).

PURPOSE: Breast cancer is the most frequent cancer in women. Early and accurate detection of the disease is a major factor in patient survival. To this end, phase-contrast imaging has gained significant interest in recent years. The aim of this work was to validate the physics models of a Geant4 mammography imaging simulation (in the context of the XPulse project) by comparing to EGSnrc results. METHODS: We used three Geant4 electromagnetic physics lists of the version 10.4 of the toolkit: Standard, Livermore and Penelope. We calculated energy distributions in homogeneous and inhomogeneous phantoms and breast doses in DICOM images. The simulations used photon beams of energies 20-100 keV. The Geant4 calculations were compared with EGSnrc/DOSXYZnrc simulations. RESULTS: We found a very good agreement between the Standard Electromagnetic option 4 and Livermore Physics Lists (within 1% for all beam energies). Larger differences were found between Standard Electromagnetic option 4 and Penelope Physics Lists (about 4%). The agreement of longitudinal energy distributions between Geant4 Standard Electromagnetic option 4 and EGSnrc was good in water and light biological materials, but important discrepancies were found in heavy elements. We confirmed with both codes that dose to the breast is minimal at beam energy around 60 keV. CONCLUSIONS: Overall, we found good agreement between the option 4 of the Standard Electromagnetic physics list and Livermore physics lists of Geant4, as well as EGSnrc for materials relevant to mammography screening. Further investigations are needed for the case of heavier materials.

[Radiation therapy for glial tumors: technical aspects and clinical indications]. / Radiothérapie des tumeurs gliales: techniques et indications.

Radiotherapy of glial tumors is rapidly evolving with the recent technical and therapeutic progress. About technical aspects, progress in technical imaging and development of non-coplanar conformal and IMRT techniques provide new possibilities for sparing healthy tissue while increasing dose in tumoral volume. Furthermore, functional and molecular imaging are helpful for delineation and for prediction of relapse. Even modest, the actual improvement of survival with radiochemotherapy leads now to new and important developments for clinical research according to clinical data (age, general status), biological data (MGMT promotor methylation and cytogenetic modifications) and technical data (quality of surgery and radiotherapy). Understanding of molecular mechanisms allows for rational targeting or specific pathways of repair, signaling angiogenesis associated with surgery and radiotherapy in a multidisciplinary approach.

[Interest of radiotherapy of rectal cancer with synchronous metastases]. / Intérêt de la radiothérapie dans le traitement de la tumeur primitive rectale lorsque sont associées des métastases synchrones.

PURPOSE: There is no consensus about the treatment of rectal tumour when there are synchronous metastases. The interest of radiotherapy is debated. PATIENTS AND METHODS: Thirty-seven patients with rectal tumour and synchronous metastases were treated with radiotherapy first between September 1994 and December 2004. We analysed the tolerance, local control, resecability, overall survival of such a therapeutic strategy. RESULTS: The mean follow-up was 30 months. Twenty-four tumors were resecable for both the primary site and the metastases. Thirteen were unresecable at the time of diagnosis. Thirty-three patients were treated with radiochemotherapy, ten with radiotherapy alone. Eighty-six decimal five percent of them had no pelvic symptom six weeks after the treatment. Twenty-one rectal tumours were finally resected. The disease progressed in six cases during the radiotherapy. Surgery of the metastases was possible for 12 patients with tumour initially resecable. CONCLUSION: Radiochemotherapy is a "tolerable" treatment, in spite of more frequent urinary or digestive side-effects. But, if there is no surgery, palliative effect of radiotherapy is limited.

[Radiotherapy for soft tissue sarcomas of extremities. Preliminary comparative dosimetric study of 3D conformal radiotherapy versus helical tomotherapy]. / Radiothérapie postopératoire des sarcomes des tissus mous des extrémités. Etude dosimétrique préliminaire comparative de la radiothérapie conformationnelle avec la tomothérapie hélicoïdale.

PURPOSE: To evaluate dosimetry of helicoidal tomotherapy versus three-dimensional conformal radiotherapy (3D-CRT) with and without IMRT for the treatment of soft tissue sarcoma (STS) of the thigh. METHODS AND PATIENTS: A retrospective study was performed for three patients who received 3D-CRT as adjuvant radiation therapy for STS of the thigh. These three patients had a tumor in posterior, adductor or anterior compartment of the thigh. In each case, three treatments plans were optimised in tomotherapy, without bloc, with directional bloc and complete bloc of controlateral limb, to adequately treat the planning target volume and spare organ at risk. For each patient, we compare the three modalities of tomotherapy or "classical" IMRT from a clinac with the 3D-CRT actually performed for the treatment. RESULTS: Tomotherapy provides improved PTV coverage and dose homogeneity. This benefit was comparable in the three tomotherapy plans. The average D95% for tomotherapy and 3D-CRT were 97.6% and 94.8% respectively and the standard deviation is, at least, divided by two with conformal and is always better than performed with a clinac. The volume of the surrounding soft tissues receiving at least full prescription and hot spots, as evaluated by D2%, were significantly reduced in tomotherapy. Nevertheless, the results concerning the skin, the femur and the gonads were dependent on the tumor site in the thigh and not always improved with tomotherapy dosimetric studies. CONCLUSIONS: For this preliminary study, tomotherapy can provide better coverage and dose uniformity in PTV and minimize the volume of surrounding muscular tissues receiving high doses. However, in this study, there is no benefit for others OAR (skin, femur and gonads) except in particular constraint (for instance for a precise sparing of cutaneous or bony area). Other dosimetric studies, followed by prospective evaluations with long-term follow-up are needed to determine whether tomotherapy can improve outcome for patients with STS of the thigh.

Pre- and postoperative radiotherapy for extremity soft tissue sarcoma: Evaluation of inter-observer target volume contouring variability among French sarcoma group radiation oncologists.

PURPOSE: The purpose of this study was to evaluate, during a national workshop, the inter-observer variability in target volume delineation for primary extremity soft tissue sarcoma radiation therapy. METHODS AND MATERIALS: Six expert sarcoma radiation oncologists (members of French Sarcoma Group) received two extremity soft tissue sarcoma radiation therapy cases 1: one preoperative and one postoperative. They were distributed with instructions for contouring gross tumour volume or reconstructed gross tumour volume, clinical target volume and to propose a planning target volume. The preoperative radiation therapy case was a patient with a grade 1 extraskeletal myxoid chondrosarcoma of the thigh. The postoperative case was a patient with a grade 3 pleomorphic undifferentiated sarcoma of the thigh. Contour agreement analysis was performed using kappa statistics. RESULTS: For the preoperative case, contouring agreement regarding GTV, gross tumour volume GTV, clinical target volume and planning target volume were substantial (kappa between 0.68 and 0.77). In the postoperative case, the agreement was only fair for reconstructed gross tumour volume (kappa: 0.38) but moderate for clinical target volume and planning target volume (kappa: 0.42). During the workshop discussion, consensus was reached on most of the contour divergences especially clinical target volume longitudinal extension. The determination of a limited cutaneous cover was also discussed. CONCLUSION: Accurate delineation of target volume appears to be a crucial element to ensure multicenter clinical trial quality assessment, reproducibility and homogeneity in delivering RT. radiation therapy RT. Quality assessment process should be proposed in this setting. We have shown in our study that preoperative radiation therapy of extremity soft tissue sarcoma has less inter-observer contouring variability.

[Epithelioid sarcoma: a retrospective study of conservative treatment with initial surgery and radiotherapy]. / Sarcomes épithélioïdes: étude rétrospective après chirurgie conservatrice et radiothérapie.

INTRODUCTION: Epithelioid sarcoma is a rare type of soft tissue sarcomas with a high risk of recurrence both local and distant. The place of surgical conservative treatment and the role of radiation therapy remain controversial. PATIENTS AND METHODS: A serie of 9 consecutive patients treated with initial conservative surgery and postoperative radiotherapy (median dose of 52.8 Gy) from 1987 to 2006 in the same institution was analyzed. RESULTS: With a median follow-up of 40 months (range 15-153 months), the rate of local, nodal and distant relapse is respectively 56%, 11% and 33%. The rate of death is 44.5%. No imputation has been performed. CONCLUSION: Even with a high rate of local relapse observed, a conservative treatment doesn't seem to influence badly the overall survival (55.5% alive at 40 months). Indeed the rate of distant relapse and death are comparable with those found in the literature. Moreover relapse occurred almost within the irradiated volumes. An improvement of dose could be also discussed.

[French national evaluation for helicoidal tomotherapy: description of indications, dose constraints and set-up margins]. / Evaluation nationale de la tomothérapie hélicoïdale: description des indications, des contraintes de dose et des seuils de repositionnement.

After a request for proposal initiated by National Institute against cancer (INCa) in 2005, three French centers in France started tomotherapy in the first semester of 2007. A national policy of evaluation was performed to study the feasibility of this innovative technique and to compare the interest of helicoidal tomotherapy with other modalities of conformal therapy. Common protocols have been designed to facilitate this evaluation. Description of dose, IMRT levels and constraints are achieved according to each selected indication as: sarcoma, head and neck tumors, lung cancer, mesothelioma, bone metastases, anal carcinoma and craniospinal irradiation.

Introduction of external magnetic fields in entropic moment modelling for radiotherapy.

One of the big challenges of the emerging MRI-guided radiotherapy is the prediction of an external magnetic field effect on the deposited dose induced by a beam of charged particles. In this paper, we present the results of the implementation of the Lorentz force in the deterministic M1 model. The validation of our code is performed by comparisons with the Monte-Carlo code FLUKA. The relevant examples show a significant modification of the shape of dose deposition volume induced by the external magnetic field in presence of heterogeneities. A gamma-index analysis 3%/3mm shows a good agreement of our model with FLUKA simulations.

[Lung dose constraints for normo-fractionated radiotherapy and for stereotactic body radiation therapy]. / Doses aux organes à risque en radiothérapie conformationnelle et en radiothérapie stéréotaxique : les poumons.

Radiation-induced lung disease (RILD) is common after radiation therapy and represents cornerstone toxicities after treatment of thoracic malignancies. From a review of literature, the objective of this article was to summarize clinical and non-clinical parameters associated with the risk of RILD in the settings of normo-fractionated radiotherapy and stereotactic body radiation therapy (SBRT). For the treatment of lung cancers with a normo-fractionated treatment, the mean lung dose (MLD) should be below 15-20Gy. For a thoracic SBRT, V20Gy<10% and MLD<6Gy are recommended. One should pay attention to central tumors and respect specific dose constraints to the bronchial tree. The recent technological improvements may represent an encouraging way to decrease lung toxicities. Finally, our team developed a calculator in order to predict the risk of radiation pneumonitis.

Prospective evaluation of quality of surgery in soft tissue sarcoma.

BACKGROUND: Prospective application of the French Sarcoma Group (FSG) method of surgery reporting in soft tissue sarcoma (STS) in a single centre. METHODS: Patients with primary STS of the extremities or trunk wall consecutively operated at the same institution from January 1996 to December 2002 were evaluated for local recurrence (LR). There were 205 patients, with AJCC/UICC stages III and IV in 51% of cases. Resection types according to FSG were R0 in 147, R1 in 53 and R2 in five cases. Radiotherapy was delivered in 163 patients and chemotherapy in 103. Multivariate analysis was performed. Overall five-year survival was 75%. Median follow-up for surviving patients was 53 months. RESULTS: Actuarial five-year LR incidence was 13% in 200 patients with gross resection (R0+R1), it was 7% in R0 and 30% in R1 patients (p<0.0001). At univariate analysis, significant prognosticators for LR were age, histotype, tumour invasion, grade and resection type R. At multivariate analysis, resection R1 (relative risk (RR) 4.3, p=0.001) and grade 3 (RR 3.9, p=0.013) independently predicted LR. Combining these two variables produced three prognostic groups for LR: group 0 (no factor, n=70), group 1 (one factor, n=94) and group 2 (two factors, n=36) with five-year LR of 4%, 12% and 39%, respectively (p=6.4x10(-7)). CONCLUSION: This first prospective evaluation of surgery reporting in STS evidences a fourfold, highly discriminating difference in LR between resections R0 and R1.

[Conservative and functional management for soft tissue sarcomas of the extremities: role of radiotherapy]. / Approche conservatrice et fonctionnelle dans les sarcomes des tissus mous des membres : place de la radiothérapie.

Recent publications have permitted to quantify the benefit of radiotherapy in the conservative treatment of soft tissue sarcoma of the limbs. The aim of this review is to focus on aspects of radiotherapy witch influence local control and functional outcome for early and late normal tissue damage. The evaluation of late effects is performed according to Soma-Lent (Subjective-Objective-Management-Analytic-Late Effects of Normal Tissues) classification. About complications, neurological complications are probably under estimated and are related to total dose of radiation therapy.

[Helical tomotherapy: general methodology for clinical and dosimetric evaluation (national French project)]. / Questions d'actualité: schéma général d'élaboration des protocoles de tomothérapie hélicoïdale pour chaque localisation.

The methodology and choice of criteria and indexes used for a common evaluation of helical tomotherapy by 3 French centres are described. After a selection of clinical indications and definition of the general purpose are successively described the criteria and index selected for: 1) description of volumes and adaptation for on board imaging; 2) dose prescription and constraints related to IMRT; 3) intercomparaison of volumes and doses and potential dosimetric gain with this new equipment.