title: [Strategy for technical evaluation in radiation oncology: methodological and ethical aspects, the French society for radiation oncology's opinion].
abstract: Evidence-based medicine is a paradigm founded on a hierarchy of research design, accepted as a dogma. Applied to radiation oncology, and specifically to radiotherapy technical comparisons, evidence-based medicine implies methodological and ethical problems. The concept of "incremental" evolution and the dosimetric evidence are proposed as an acceptable alternative to comparative clinical trials if total dose, time, fractionation, and target volumes are not modified. For other situations, either randomized comparative trials or observational studies are needed. When randomized comparative trials are not possible, observational studies, whose validity can be enhanced by appropriate methodology, must be considered as a valid method.
authors.affiliation: Institut Sainte-Catherine, 250, chemin de Baigne-Pieds, CS 80005, 84918 Avignon cedex 9, France. Electronic address: b.chauvet@isc84.org.
authors.forename: B
authors.initials: B
authors.lastname: Chauvet
authors.affiliation: Service de radiothérapie-oncologie, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
authors.forename: F
authors.initials: F
authors.lastname: Mornex
authors.affiliation: Institut de cancérologie de l'Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain cedex, France.
authors.forename: M-A
authors.initials: MA
authors.lastname: Mahé
mesh_terms: D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D016021:Epidemiologic Studies; D019317:Evidence-Based Medicine; D005602:France; D006801:Humans; D009369:Neoplasms / Q000532:radiotherapy; D064887:Observational Studies as Topic; D018787:Radiation Oncology / Q000941:ethics / Q000379:methods* / Q000592:standards; D011874:Radiometry; D011878:Radiotherapy / Q000941:ethics / Q000379:methods / Q000592:standards*; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic; D012955:Societies, Medical; D016896:Treatment Outcome
keywords: Essais randomisés; Ethics; Evidence-based medicine; Médecine fondée sur les preuves; Observational studies; Oncologie radiothérapique; Radiation oncology; Randomized trials; Éthique; Études observationnelles