Can Modern Radiotherapy be used for Extensive Skin Field Cancerisation: An Update on Current Treatment Options

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.