Split Course Superficial Radiotherapy in Scrotal Extramammary Paget’s Disease Allows Course Completion With Minimal Side Effects: A Case Study

Nurses play an important role in the care of patients treated with radiotherapy (RT) for skin conditions such as skin cancers. A series of four articles will aim to supplement general oncology nurse training by providing a scientific basis to better understand the skin and its diseases, the use of RT in skin, and the management of necessary acute skin RT reactions to achieve best patient outcomes. The first article focused on the role of the nurse within the radiation oncology department and the initial patient assessment. This second article describes the anatomy, physiology, pathology and radiobiology of skin and its diseases. These concepts are fundamental to the understanding of how acute effects develop during treatment and how to best care for them. The transition time of normal keratinocytes in the epidermis from creation to demise (10-14 days) is discussed as essential to understanding the timing of acute RT effects. The effect of RT on DNA, and the different effects of RT on normal cells versus tumour cells, which underscore fractionation and normal tissue conservation, are also discussed. Finally, this article addresses the late effects of RT in normal skin, accelerated repopulation, types of skin cancers and their relative radiosensitivities, and the effects of RT on benign skin diseases. The third article will describe the skin RT prescription and plan, especially in relation to volume and dose; and the fourth will show how the nurse, by applying the knowledge from the previous articles, can predict, explain and care for the acute side effects that may arise during a course of skin radiotherapy.

Section: Does the Problem Of Accelerated Repopulation Occur In Skinmentioning

confidence: 99%

A scientific approach to skin radiotherapy nursing Article 2 - The anatomy, physiology, pathology and radiobiology of skin and its diseases

Fogarty¹,

Mallon²,

Athar³

et al. 2022

“…The indications for RT in benign disease such as keloids, 21 rosacea, 9 psoriasis, 10 hidradenitis suppurativa; 22 and in-situ disease, such as extramammary Paget's disease 23 and extensive skin field cancerisation, 24 are growing. These patients may have different expectations, especially about survival, from those receiving RT for non-skin invasive cancers like breast and prostate cancers.…”

Section: Treatment For Benign Disease and In Situ Diseasementioning

confidence: 99%

A scientific approach to skin radiotherapy nursing Article 1 - The role of the nurse in patient assessment

Fogarty¹,

Sutton²,

Christiansen³

et al. 2022

Nurses play an important role in the care of patients treated with radiotherapy (RT) for skin conditions, such as skin cancers. A series of four articles will aim to supplement general oncology nurse training by providing a scientific basis to better understand the skin and its diseases, the use of RT in skin, and the management of necessary acute skin RT reactions to achieve best patient outcomes. This first article focuses on the role of the nurse within the radiation oncology department and the initial patient assessment. It enables the nurse to develop an appreciation of the unique nature of patients undergoing RT to the skin and provides recommendations on nursing assessment, patient examination, and optimal care of the skin RT patient. It also highlights the psychological impact of a skin cancer diagnosis on the patient. The second article in this series of four revises the anatomy, physiology, pathologies and radiobiology of skin. The third describes the skin RT prescription and plan, especially in relation to volume and dose; and the fourth shows how the nurse, by applying the knowledge from the previous articles, can predict, explain and care for acute side effects that may arise during a course of skin radiotherapy.

“…27 In situ disease seems to handle a break without loss of oncological control. 12,28 Plan acceptance then takes place. This demands attention to detail, notably to PTV coverage and doses to organs at risk (OARs).…”

Section: Planningmentioning

confidence: 99%

Experiences in growing a skin radiation therapy practice

Fogarty¹,

Christie²,

Wong³

et al. 2020

The successful treatment of skin disease decreases morbidity and mortality. Radiation therapy (RT) can cure skin disease and conserves tissue, possibly delivering better quality of life post treatment and so a superior survivorship. Modern RT delivers better dose conformality and homogeneity, and more is known about the radiobiology of skin and its diseases, enabling treatment personalisation. Skin, however, can be viewed in RT departments as not a serious subspecialty, even in Australia where the incidence of skin cancer is highest. Radiation oncology leaders are needed to carve out a niche for RT amongst a crowded field of skin carers. This article based on the cumulative experience of a group of Australian skin radiation oncologists (ROs), details how this may be achieved. First, focus is placed on growing a high-quality service. The RO needs to understand how patient, tumour and treatment factors impact the skin RT prescription. The particular nuances around skin RT planning, including immobilisation, simulation, contouring and the advantages and disadvantages of each RT modality in skin, are important to know. How skin reacts to RT when the skin is the target and the importance of fractionation is essential knowledge. Second, the RO needs to understand the needs of the skin stakeholders. These include those in the department who look to them for leadership. It includes those outside the department, that is, patients and other skin carers who could be future colleagues and even referrers. Third, the RO needs to use much needed research as a way to bring the disparate skin caring community together through completing high-quality research to guide therapy and post-treatment care.