Authors' objectives:

This report aims to evaluate a project by the AP-HP to acquire a Gamma Knife for radiosurgery which includes the Gamma Plan software package and the Gamma Link digital network.

Authors' results and conclusions: The studies available do not provide evidence demonstrating the superiority of either the Gamma Knife or the LINAC (lineal particle accelerator) procedure in terms of clinical benefit to the patient, and particularly with regard to the success rates in obliterating arterio-venous malformations or controlling tumour lesions. Regulatory considerations are not decisive, despite what has been envisaged in some places. Which ever instrument is chosen, the legislative constraints will be the same: the same ministry permit is required, purchase and running costs to be met in the context of the global funding. Other arguments are conflicting. Technological progress and the cost of the investment both argue in favour of a LINAC (about one third of the costs), but the quality assurance procedures for this type of instrument are more complex. Relative simplicity of use and sturdiness argue in favour of the Gamma Knife, but the high purchase price, the high cost of replacing the cobalt source every 5 to 7 years and above all the fact that this instrument is restricted to use for treating brain lesions militate against it.

Authors' recommendations: The CEDIT recommends that a unit, dedicated to stereotaxic radiotherapy, which will be able to treat all the patients in the Ile-de-France be set up within the AP-HP. A multidisciplinary working party should be constituted to recommend a suitable site and working conditions, bearing in mind that the CEDIT recommends a 'shared equipment' type of organisation that will provide access for all competent teams. This unit will be strongly focused on clinical research, enabling it to explore the various areas listed above . It will function under the supervision of a team of co-ordinators, who will be responsible for drawing up consensus protocols and a system of regular evaluation. The make-up of this team should reflect the multidisciplinary nature of the technique and draw on the expertise of teams with greater experience in this field, particularly that at the Tenon Hospital.

Authors' methods: Overview

Project Status: Completed

URL for project: http://cedit.aphp.fr/

Year Published: 1997

English language abstract: An English language summary is available

Publication Type: Not Assigned

Organisation Name: Cellule Innovation of the AP-HP

Copyright: Comite d'Evaluation et de Diffusion des Innovations Technologiques