ABSTRACT
Stereotactic radiotherapy delivers allows for a highly precise irradiation, and was originally developed in the 70s by neurosurgeons. Gradually, it has been developed in extracranial indications. Moreover new innovative treatment devices such as the robotic radiosurgery with CyberKnife have emerged. Indications are currently being validated by the HAS in intracranial locations that are treated by conventional radiosurgery for several decades. Three robotic radiosurgery facilities were opened in France in 2006 thanks to a grant from the INCa. Those are posed in Lille, Nice, Nancy. Since 2007, 140 patients were treated as off today in Alexis Vautrin Cancer Center (40 intracranial locations, 100 extracranial). Thirty five primitive lung cancer or pulmonary metastasis, twenty primary liver tumor or metastasis, 21 spinal locations (schwanomas or bone metastasis), and nineteen other (pelvic lymph nodes, chordomas, H&N, etc.). The lung diseases were treated on the 80% isodose as follow: 60 Gy in three fractions for peripheral tumors and 54 Gy for central ones. The one-year local control rate reaches 90%. The hepatic tumors received 45 Gy in three fractions prescribed on the 80% isodose with a six months local control rate of 83%. Any of the 140 patients has suffered from acute or late toxicity > grade 3. These encouraging outcomes are confirmed by both other French centers and phase II trial are pending to assess the most effective and safe radiations protocols.
