Can Modern Radiotherapy be used for Extensive Skin Field Cancerisation: An Update on Current Treatment Options
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 4, Issue 1
Abstract
The use of Radiotherapy (RT) for skin cancer by dermatologists has decreased since the latter half of last century for many reasons. Driven by clinical need, radiation oncologists, radiation biologists and physicists, have progressed RT in many ways over the course of the last fifty years. The creation of multidisciplinary meetings for clinicians involved in skin cancer has put the specialisties of dermatology and radiation oncology in touch. With better modalities and techniques, is there a new role for RT in skin cancer?. A particular scenario is the treatment of Extensive Skin Field Cancerisation (ESFC), where in situ disease can cause significant symptoms and can lead to invasive disease. Current dermatologic and traditional radiation treatments have been disappointing, especially for large convex surfaces of sun-exposed areas such as scalps. These therapies all suffer from a top down problem. To give enough treatment to fully sterilize in situ disease in deep skin appendages, unacceptable side effects can be suffered in the more superficial layers, sometimes leading to a lack of compliance. This review explains recent advances in RT that allow a more homogenous RT dose through the skin treatment volume. Trials need to be performed with modern RT in ESFC. The review also attempts to set some meaningful definitions that can be used for trials. Hopefully these efforts will lead to better oncological, functional, and cosmetic outcomes for patient suffering from ESFC. Radiotherapy (RT) for skin cancer was a common treatment administered by dermatologists until the 1980s. Better surgical and topical treatments, coupled with increasing radiation regulatory requirements, led to a decline in the use of RT by dermatologists. RT has continued to evolve in the treatment of other cancers. Driven by radiation oncologists, radiation biologists and physicists, RT has progressed in many ways. High quality Randomised Controlled Trials (RCT) has led to an increase in the indications for RT in many tumour types. The creation of multidisciplinary meetings for clinicians involved in skin cancer has put the specialities of dermatology and radiation oncology in touch. This has led to dermatologists asking whether there is a new role for modern RT in the treatment of skin cancer. A particular scenario is the treatment of Extensive Skin Field Cancerisation (ESFC). Patients can suffer with ESFC caused by chronic ultraviolet radiation exposure (Figure 1) Actinic Keratosis (AK), Bowen's disease or Intraepidermal carcinoma (IEC) are found in ESFC from which new invasive Cutaneous Squamous Cell Carcinoma (cSCC) can arise[1]. This disease can cause significant morbidity and poor quality of life, with itch, flaking skin and poor cosmesis. Patients often have comorbidities that preclude other treatments, especially surgery if complex closure is required. Patients may also decline surgery because of fear of a poor functional or cosmetic outcome with the tissue loss that surgery entails. Current dermatologic treatments have been disappointing, especially for larger convex surfaces of sun-exposed areas such as scalps. Recurrence at twelve months is common [2-4]. Not all therapies are readily available. Application can be painful. Skin reaction, sometimes a necessary measure of efficacy, can be unsightly, painful and require significant care including dressings.
Authors and Affiliations
Fogarty GB, David Christie, Lynda J Spelman, Madeleine J Supranowicz, Robert J Sinclair
Keywords
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- EP ID EP590797
- DOI 10.26717/BJSTR.2018.04.000998
- Views 133
- Downloads 0
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