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Radiotherapy alone or in association with systemic treatment plays a major role in the treatment of head and neck tumours, either as a primary treatment or as a postoperative modality. The management of these tumours is multidisciplinary, requiring particular care at every treatment step. We present the update of the recommendations of the French Society of Radiation Oncology on the radiotherapy of head and neck tumours from the imaging work-up needed for optimal selection of treatment volume, to optimization of the dose distribution and delivery. [ABSTRACT FROM AUTHOR]

The purpose of this article is to describe the regulatory framework of the radiotherapy practice in France. [ABSTRACT FROM AUTHOR]

We present an update of the French society of oncological radiotherapy recommendation regarding indication, doses, and technique of radiotherapy for intrathoracic metastases. The recommendations for delineation of the target volumes and critical organs are detailed. [ABSTRACT FROM AUTHOR]

Résumé Les indications des traitements délivrés en conditions stéréotaxiques connaissent, à l’heure actuelle, un développement considérable devant l’émergence de nouvelles indications. Les conditions de réalisation de ces traitements sont multiples. L’étape initiale est essentielle, elle concerne la validité de l’indication au regard du niveau de preuve grâce auquel elle est proposée en réunion de concertation multidisciplinaire. Ces techniques émergentes ne bénéficient pas d’évaluation à long terme pouvant être considérée comme définitives pour les traitements extracrâniens, d’une part, de leur efficacité et, d’autre part, des seuils de tolérance des tissus sains. C’est dire la priorité qui doit être offerte aux patients de bénéficier des études cliniques prospectives, indépendantes, validées par un conseil scientifique indépendant, encadrées dans un programme d’assurance de qualité pertinent et multicentrique qui favorise la connaissance et la sélection des indications. La Société française de radiothérapie oncologique (SFRO) prépare dans son guide des procédures la description des conditions de réalisation de ces traitements et elle collabore avec tous les acteurs institutionnels à la rédaction de guide de pratique qui permettront d’offrir le cadre estimé prérequis indispensable à tous, patients et professionnels de la radiothérapie. Indications of treatment by stereotactic body radiotherapy are dramatically increasing due to new potential indications. The conditions associated with the treatment delivery are multiple. The first step of the process is crucial. It is related to the validation of the indication proposed during the multidisciplinary meeting as regard the evidence-based proof of the concept. These emerging techniques mainly extracranial stereotactic body irradiation do not benefit from long-term evaluation in terms of efficiency as well as normal tissue late toxicities. Priority should be given to prospective independent clinical trials, validated by an independent scientific committee, performed under a relevant and well dedicated multicentric quality assurance program aiming to improve knowledge and selection of indications. The SFRO is still working with others professionals on the definition of the conditions for the implementation of such treatments and actively collaborates with the authorities to define the appropriate conditions to preserve the quality of the treatment delivery under these specific conditions. [ABSTRACT FROM AUTHOR]

Abstract: In medicine, as in oncological radiotherapy, as elsewhere, the precept of quality has no meaning if it is not defined. In France as everywhere radiotherapy has its forces and its weaknesses. As in every country, its future seems assured by its character cost effective as by its capacity to make progress in the triple point of view of its equipment, its professions and its organization. However, the French radiotherapy is in crisis. The professionals saw clearly. For more than 10 years they had recalled the medical authorities to their responsibilities concerning the demographic trends for the radiotherapists and the physicists, the renovation of the equipment, the modernization of the organizations, the promotion of the evaluation of procedures and outcomes and the development of a greater fairness in the financings. But the delay taken, the setting under pressure of the professionals by the State, its services, its agencies and the media following the recent accidents cause numerous perverse effects and worried the staff. The accident of Épinal was the starting fact of an effort of professionalisation of the risk management, but also of a disturbed period favourable with a certain confusion of minds, discouragement and protective behaviors. The risks felt by the professionals then seem especially to come from the authorities and the media. It appears that the topic of quality is at the center of all these speeches. Under this vocable, it is in fact the respect of the procedures related to the requirement of security which is privileged by the State and its representatives. The apparent security seems to override the real quality of the practices. Thus, time came for a clarification of the quality and security concepts, of organizations which contribute to it and for the development of a clear strategy bringing together the interprofessionnal actors. In this context, the implication of the College and especially of the Société française de radiothérapie oncologique is a requirement. [Copyright &y& Elsevier]

Abstract: In 2004, three new important laws were passed concerning radiotherapy services. The first two concerns the internal and external quality control of linear accelerators and the last concerns the role of the medical physicist, whose presence was made mandatory during the whole length of the treatments. These laws, which aim to improve the quality and the security of treatments, represent an increase in price that we have calculated, and which prevents them being implemented, as a joint study realised by the SFRO and the SFPM has shown. The cost of quality in radiotherapy requires investment in material and manpower and improvement in availability of the accelerators which entails a complete reorganisation of the services. Cost analysis is included. The difficulties in implementing these laws have also been evaluated and this evaluation already enables us to propose certain elements enabling us to go forward to globally improve the quality and security in radiotherapy. [Copyright &y& Elsevier]

Résumé Le but de cet article est de décrire le contexte réglementaire de l’exercice de la radiothérapie en France, les processus de radiothérapie externe et de curiethérapie et les recommandations du suivi des patients. The purpose of this article is to describe the regulatory framework of the radiotherapy practice in France, the external irradiation and brachytherapy process and the guidelines for patient follow-up. [ABSTRACT FROM AUTHOR]

Résumé Le but de cet article est de décrire les spécificités de la radiothérapie pédiatrique : types de cancers, indications, techniques, organisation et réglementation. The purpose of this article is to describe the specificities of paediatric radiation oncology: cancer types, radiotherapy indications, techniques, organisation and reglementary framework. [ABSTRACT FROM AUTHOR]