“What that highlights is that it’s never one size fits all. Having specialists working in collaboration will certainly get the best outcome for a patient in terms of having access to all of the options, but more importantly, choosing the option which is best for their circumstances.”
– A/Prof Matthew Foote
Treating skin cancers with radiation therapy
Treating skin cancer with radiation therapy
Find an Australian who hasn’t had skin cancer treatment or knows someone who has, and you’ll have found a rare individual.
Skin cancer impacts so many lives in Australia, with two-thirds of Australians diagnosed with skin cancer by the age of 70. That adds up to a shocking 750,000 people being treated for at least one non-melanoma skin cancer every year.
The cancer develops when skin cells are damaged by UV radiation from the sun. Sunburn, tanning and the use of solariums increase the risk and are part of the reason Australia has one of the highest skin cancer rates in the world.
And while most people have their skin cancers successfully removed, it can be deadly, killing 2,162 Australians every year. But there are several treatment options available.
Radiation therapy can be an effective non-invasive way to treat skin cancers. Machines such as the Esteya Superficial Brachytherapy System available at Icon’s Greenslopes centre in Brisbane, mean doctors can treat early skin cancers non-invasively and effectively, with good cosmetic outcomes. For more advanced stages of skin cancer, volumetric arc radiation (VMAT) via a linear accelerator, the machine that delivers radiation therapy, gives doctors unprecedented control over the radiation dose they use, which allows them to better target complex lesions or tumours on the body without damaging the surrounding healthy areas. Linear accelerators can also be used to treat a range of skin cancers, from early to advanced stages. Radiation treatment for skin cancers also allows patients to continue their medication regimes, particularly for patients on blood thinning medications, such as warfarin.
“They work by using directed radiotherapy to the lesion, which ultimately causes death of the cancer and by targeting it to the lesion specifically, it reduces any dose to the surrounding normal tissue, which means a very low chance of any significant side effects. Radiation treatment is also particularly beneficial for patients on blood thinning medications as there is no changes to their medication regime, which is convenient to the patient and keeps their readings consistent,” Radiation Oncologist Associate Professor Matthew Foote explains.
These treatments are non-invasive, with treatment programs specifically planned for each patient. Depending on the size and complexity of the treatment required, visits to the cancer treatment centre usually take around 20 minutes, with the length of the program ranging from as little as four visits to as many as 30 for more complex cases.
Radiation therapy has an important role in the treatment of all commonly diagnosed skin cancers including Basal cell carcinoma (BCC), Squamous cell carcinoma (SCC) and melanoma, as well as the less common Merkel cell skin cancer.
“For example, it could be used for early BCCs and SCCs in parts like the face, particularly in patients who would prefer not to have further surgery,” Dr Foote says. “In terms of those cancers it can be used as an adjuvant after surgery for high-risk lesions.” Adjuvant means a therapy used after an initial surgery or other treatment for cancer, usually to reduce the likelihood of secondary cancers forming.
While vanity is usually a secondary consideration for most people when it comes to having a skin cancer removed, most Aussies know someone with significant scarring from treatment. But Dr Foote says radiotherapy technology has come a long way in recent years and now provides very good cosmetic outcomes for small, obvious areas such as the nose or mid-face, while allowing doctors to continue to successfully treat patients with cancers that cover a wide area of the body.
“Many people in their 60s may have these preconceived ideas of people getting these bad burns over many parts of their body with radiotherapy and that’s based on very old techniques,” he says.
“It’s important to understand how significant these changes in technology have been to enable us to target the tumour itself and limit the dose to surrounding structures and therefore making the treatment very safe, highly targeted and very effective.”
Cutting-edge technology also means treating lesions with radiation therapy isn’t as painful as it once was. Most patients only experience mild discomfort similar to having a patch of sunburn, and anaesthetic isn’t commonly used for this part of treatment.
“Even in the last five years, the technological developments have been immense,” Dr Foote says. “The ability to target not just skin cancers but lesions throughout the body with highly targeted radiotherapy is leaps and bounds ahead of where it was five or 10 years ago.”
For patients with an advanced melanoma, radiation therapy is typically used in conjunction with surgery, immunotherapy or targeted drug therapy. In such cases, Icon’s doctors collaborate with surgeons who undertake surgery at other locations and medical oncologists (chemotherapy specialists). Dr Foote emphasises how this arrangement suits the fact that each patient’s treatment program is unique, with some cancers better suited to surgery, others to radiation and or chemotherapy/targeted therapy and some that require a combination these.
Basal cell carcinomas (BCCs) and Squamous cell carcinomas (SCCs) treated with radiation therapy currently have a success rate of higher than 90 per cent, while radiotherapy in conjunction with surgery sees good outcomes for people even with advanced stages of skin cancer.
Before a person can be treated for skin cancer, though, the cancer must be diagnosed, which is why it’s vital that Australians are aware of the signs and symptoms of skin cancer.
Take note of sores that don’t heal and become crusty. Small red lumps with a pearly sheen can also be a warning sign.
Any spots, moles or freckles that change colour, shape or thickness should raise concerns.
Anyone experiencing any of these symptoms should visit their GP or health professional, while annual skin checks are important even for those without any sign or history of skin cancer.
Even if cancer is detected, there are plenty of options.
“Today, technology is so good that radiotherapy becomes a very good option, particularly for patients 60 and over for treatment of a number of skin cancers,” Dr Foote says.
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