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The consequences of a dosimetric radiosurgery accident are not the same as a conventional radiotherapy accident. The objective of this study was to estimate the clinical and radiological outcome of patients treated by radiosurgery for metastasis during the period of the overexposure accident that occurred in the Toulouse Radiosurgery Unit. Between April 2006 and March 2007, 33 patients with 57 metastases were treated in the Toulouse Radiosurgery Unit (Novalis®, BrainLab). An initial error in the estimation of the scatter factors led to an overexposure to radiation. The median age was 55 years [range, 35–85]. Twenty-one patients (64%) harbored a single metastasis. The primary tumor location was lung (16 cases), kidney (nine cases), breast (four cases), and others (four cases). The mean tumoral volume was 3.2 cm3 [0.04–14.07]. The mean prescribed dose at the isocenter was 20 Gy [range, 10–23], the mean delivered dose was 31.5 Gy [range, 13–52], and the mean overdose was 61.2% [range, 5.6–226.8]. In order to evaluate the consequences of the overdose, three parameters were analyzed: a risk index using dose and volume, the volume of parenchyma that received more than 12 Gy, and the mean dose in a sphere of 20 cm3 surrounding the target volume. Median actuarial survival was 14.1 months, the survival rate was 79.4 % at six months, 59.1% at 12 months, and 27.2% at 24 months. The rate of tumor control was 80.7%. No morbidity was observed. There was no correlation between death and the parameters studied. The survival rates and times observed in our study of the patients treated for brain metastases by radiosurgery and overexposed were among the good results of the international literature. Deaths were not related to the overdose and no side effect was noted. This dosimetric accident has not had worse consequences in this population.

Resume Objectif Le but du travail est de resumer le Plan Cancer et ses applications potentielles a la Neuro-Oncologie, et d’exposer les resultats de la premiere partie de l’enquete nationale « Neurochirurgie et Neuro-Oncologie : etats des lieux ». Methode Le Club de Neuro-Oncologie de la Societe Francaise de Neurochirurgie a etabli un questionnaire qui a ete adresse a tous les services de Neurochirurgie francais. Resultats Le taux de reponse a ete de 96,5 % pour les centres hospitaliers, et 7 centres liberaux ont repondu a l’enquete. L’integralite des resultats est presentee dans le texte. Conclusion Il ressort de cette enquete, d’une part, l’interet important des neurochirurgiens pour la Neuro-Oncologie et, d’autre part, la necessite pour construire une medecine de qualite conforme aux bonnes pratiques, de developper la construction de reseaux de Neuro-Oncologie formalises permettant d’exploiter les donnees cliniques et fondamentales afin d’optimiser la prise en charge medicale. La creation du Club de Neuro-Oncologie, la publication du Plan Cancer, et les resultats de cette enquete confirment les modifications entreprises dans la prise en charge des patients. La mise en place des Unites de Concertation Pluridisciplinaire, le developpement de l’information, de la transparence, d’une prise en charge adaptee au cas par cas representent, meme si celles-ci ne sont pas encore generalisees, les principales avancees de notre medecine moderne. En pratique, les neurochirurgiens doivent poursuivre les efforts entrepris et convaincre les pouvoirs publics de la necessite de moyens complementaires pour harmoniser et optimiser la prise en charge globale des patients.