Technique for axillary radiotherapy using computer‐assisted planning for high‐risk skin cancer†

Fogarty, GB; Cassumbhoy, Robin; Martin, Jarad; Fay, Michael; Ainslie, Jill

doi:10.1111/j.1440-1673.2007.01729.x

Cited by 11 publications

(11 citation statements)

References 32 publications

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“…The field treating the primary is junctioned to the regional field if field edges are within 5cm and there is no danger of unnecessary toxicity. Axillary fields are treated as per Fogarty et al [24]. …”

Section: Methodsmentioning

confidence: 99%

Radiotherapy is associated with significant improvement in local and regional control in Merkel cell carcinoma

et al. 2012

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IntroductionMerkel cell carcinoma (MCC) is a rare tumour of skin. This study is a retrospective audit of patients with MCC from St Vincent’s and Mater Hospital, Sydney, Australia. The aim of this study was to investigate the influence of radiotherapy (RT) on the local and regional control of MCC lesions and survival of patients with MCC.MethodThe data bases in anatomical pathology, RT and surgery. We searched for patients having a diagnosis of MCC between 1996 and 2007. Patient, tumour and treatment characteristics were collected and analysed. Univariate survival analysis of categorical variables was conducted with the Kaplan-Meier method together with the Log-Rank test for statistical significance. Continuous variables were assessed using the Cox regression method. Multivariate analysis was performed for significant univariate results.ResultsSixty seven patients were found. Sixty two who were stage I-III and were treated with radical intent were analysed. 68% were male. The median age was 74 years. Forty-two cases (68%) were stage I or II, and 20 cases (32%) were stage III. For the subset of 42 stage I and II patients, those that had RT to their primary site had a 2-year local recurrence free survival of 89% compared with 36% for patients not receiving RT (p<0.001). The cumulative 2-year regional recurrence free survival for patients having adjuvant regional RT was 84% compared with 43% for patients not receiving this treatment (p<0.001). Immune status at initial surgery was a significant predictor for OS and MCCSS. In a multivariate analysis combining macroscopic size (mm) and immune status at initial surgery, only immune status remained a significant predictor of overall survival (HR=2.096, 95% CI: 1.002-4.385, p=0.049).ConclusionsRT is associated with significant improvement in local and regional control in Merkel cell carcinoma. Immunosuppression is an important factor in overall survival.

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Section: Methodsmentioning

confidence: 99%

Radiotherapy is associated with significant improvement in local and regional control in Merkel cell carcinoma

et al. 2012

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“…Patients can also develop metastatic cutaneous SCC to non‐HN nodal regions, such as the groin or axilla. These patients should similarly be recommended surgery (if operable) and adjuvant radiotherapy (50 Gy in 2‐Gy fractions) with the aim to decrease the risk of regional recurrence 41 . Patients treated with radiotherapy alone to sites of nodal metastases are less likely to be cured, although most will experience nodal regression with good palliation.…”

Section: Keratocanthomamentioning

confidence: 99%

“…39 and adjuvant radiotherapy (50 Gy in 2-Gy fractions) with the aim to decrease the risk of regional recurrence. 41 Patients treated with radiotherapy alone to sites of nodal metastases are less likely to be cured, although most will experience nodal regression with good palliation. Definitive doses should be at least 60-66 Gy using a shrinking field technique and palliative doses approximately 40 Gy in 15 fractions (or similar) to achieve a worthwhile response.…”

Section: Lip Sccmentioning

confidence: 99%

The important role of radiotherapy in patients with non‐melanoma skin cancer and other cutaneous entities

Veness

2008

J Med Imag Rad Onc

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Non-melanoma skin cancer is the commonest malignancy worldwide and a significant public health issue. Although most non-melanoma skin cancers are small and easily excised or ablated, a recommendation of definitive radiotherapy is often made in patients where the outcome (cosmetic and/or functional) will probably be better with radiotherapy compared to surgery. The aim of adjuvant radiotherapy is to reduce the risk of loco-regional recurrence and the role of palliative radiotherapy is important in improving the quality of life in patients with advanced and/or incurable disease. The aim of this review article is to broadly discuss the various clinical settings in which a recommendation of radiotherapy may be made and also includes a discussion on less frequently encountered cutaneous entities (e.g. in situ squamous cell carcinoma, keratocanthoma, lentigo maligna, cutaneous lymphomas and malignant fibrous tumours).

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“…2 For SCC and Merkel cell carcinoma, a prescription of 50 Gy in 25 fractions with fi ve fractions per week is used. 1 All axillary radiotherapy uses anterior and posterior fi elds of six megavoltage (6 MV) photons.…”

Section: Axillary Radiotherapymentioning

confidence: 99%

“…1 At the ALCC, patients presenting with melanoma, SCC or Merkel cell carcinoma are prescribed radiotherapy when there is axillary node involvement. 1 Both melanomas and SCC are treated with radiotherapy post-surgery if there is multiple node involvement, extranodal spread and nodes more than three centimetres in diameter. Primary Merkel cell carcinomas are given adjuvant radiotherapy to the clinically negative regional nodal basins that are greater than one centimetre in diameter.…”

Section: Axillary Radiotherapymentioning

confidence: 99%

Implementing results of a change process at the Andrew Love Cancer Centre — The axillary technique

Sale

Batson

2011

Radiographer

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Purpose: Change is ever present in radiation therapy departments and it can impact on the quality of work, staffi ng and job satisfaction. Understanding stages of change for individuals can assist management in successfully developing the service of their department. At the Andrew Love Cancer Centre (ALCC) there have been many developments in recent years. Th is paper aims to describe a successful change in practice at the ALCC, focusing on the quality assurance improvements made with the introduction of a new radiotherapy treatment technique used for melanoma, squamous cell carcinoma and Merkel cell carcinoma with axillary node involvement. Methods: A four-stage model of change was used to guide the introduction of the new axillary technique. Th e accuracy of the new technique was evaluated in comparison with the historical technique, using pre-treatment images. Results: A total of 219 pre-treatment images were analysed in this study, 141 with the historical technique and 78 with the new. Seven out of eight reference points indicated reductions in translational correction in fi eld placement with the new technique compared to the historical. Conclusion: Improvements in set-up accuracy were found when utilising the new set-up technique compared with the historical technique. Th e four-stage model of change assisted in the smooth implementation of this new treatment technique. At the ALCC innovation and development are encouraged, along with management having a sound understanding of organisational change enabling the radiation therapy department to develop successfully and cope with rapid change.

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Technique for axillary radiotherapy using computer‐assisted planning for high‐risk skin cancer†

Cited by 11 publications

References 32 publications

Radiotherapy is associated with significant improvement in local and regional control in Merkel cell carcinoma

Radiotherapy is associated with significant improvement in local and regional control in Merkel cell carcinoma

The important role of radiotherapy in patients with non‐melanoma skin cancer and other cutaneous entities

Implementing results of a change process at the Andrew Love Cancer Centre — The axillary technique

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