VMAT for skin cancerisation

We are the first provider in the UK to offer VMAT for skin field cancerisation

A modern technique

Volumetric modulated arc therapy – known as VMAT radiotherapy – is a promising option for extensive skin field cancerisation where other treatments no longer work or can’t be tolerated. To bring this world-leading approach to the UK, we have collaborated with GenesisCare in Australia, which has a long-established service for patients with skin field cancerisation.

Non-melanoma skin cancer is the most common cancer in the UK, but it is mostly not life-threatening. It can occur on its own or within wider areas of pre-cancerous skin tissue containing abnormal cells – this is known as extensive skin field cancerisation. Even though this is not cancerous, there’s a chance it may eventually turn into cancer if the area isn’t treated.

These pre-cancerous and cancerous tissues can return after treatment, meaning that those treatments may need to continue for many years, affecting your quality of life, and they may become ineffective or not well tolerated.

Is VMAT radiotherapy for me?

Having VMAT radiotherapy treatment may be suitable for you if you have extensive skin field cancerisation and if you’ve previously tried other treatments, such as skin creams or photodynamic therapy, that have not worked.

VMAT radiotherapy may also be recommended for you if you’re unable to tolerate other treatments, for instance if they cause a lot of skin inflammation or pain.

Book an appointment

Contact us today to find out if VMAT is right for you.
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What is VMAT radiotherapy

VMAT is a modern radiotherapy technique that works by delivering a continuous beam of radiotherapy in an arc around your body. As the machine (called a linac) moves, it changes the beam shape and treatment dose automatically. It’s very accurate and maximises the radiation dose to the tumour while minimising the overall dose to surrounding healthy tissue. This greatly reduces the side effects expected from traditional radiotherapy to the skin – such as scarring or spider veins.

VMAT radiotherapy can be used to safely treat the skin surface without treating the underlying healthy tissue. It can be used even in highly curved areas, such as whole arms or legs, and to protect organs that lie beneath the skin, such as in the head and neck area.

 

What does treatment involve?

Here is an outline of what to expect during your treatment at GenesisCare. There are five stages to the process: your initial CT scan appointment, second CT scan appointment, planning, treatment and follow-up.

3D bolus is a type of plastic material used to shape the radiation beam during each treatment session. This enables your care team to maximum dose to the treatment area while minimising dose to underlying healthy tissue, improving the accuracy and safety of treatment.

Before your treatment, you’ll be fitted with a personalised 3D bolus that fits exactly over the area being treated. For this complex process, we use the latest 3D printing and a special material which will evenly distribute the radiation across the target skin field.

First appointment

The appointment will take between 30 and 60 minutes and will involve a computed tomography (CT) scan. This is used to develop your personalised 3D bolus that’s needed during each treatment session.

 

  1. Your radiographer will position you for your CT scan using equipment to keep your treatment site still. For treatment to your head and neck, this will be a plastic (“thermoplastic”) mask (made at a second CT appointment) and for other treatment sites you’ll be positioned using vacuum formed bags
  2. Your area(s) to be treated will be marked on the skin with pen and any ‘boost areas’ – where there is a cancer within the field – will also be marked
  3. Next, your radiographer will take photographs of the area(s) to be treated
  4. Your radiographer will then put wire over your markings, so the area can be seen on the CT scan
  5. Once you’re comfortable, the CT scan can begin. You may need more than one scan if you’re having multiple sites treated
  6. Once the scanning is complete, you can go home

 

Second appointment

You’ll come back for your second planning appointment one or two weeks later, once your 3D bolus is ready.

  1. You’ll be positioned as you were for your first CT appointment, but this time with the 3D bolus in place over the area(s) to be treated. If you’re having an area on your head treated, the radiographers will also make a thermoplastic mask at this point, in order to keep your head still during your treatment sessions
  2. Once you’re comfortable, the CT scan can begin. You may need more than one scan if you’re having multiple sites treated
  3. Once the scanning is complete, you can go home

 

Your consultant will use your CT scans and advanced computer technology to create a treatment plan. They will outline the treatment site(s), the boost areas, and any organs that are in close proximity to these sites on the plan so they know where to target the dose.

 

Your treatment will be delivered over the course of around five weeks, for 10 to 20 minutes each day. You can go home after each session. If you’re receiving treatment for your lower limbs, there will be a gap of at least two weeks after your tenth session in order to help the skin recover before restarting the treatment. For other treatment sites, you may or may not require a break from treatment, but this will be discussed with you.

During your treatment, you’ll be reviewed each week by your oncologist and radiographer to assess your skin and provide support for any side effects you’re experiencing.

Once your treatment course has finished, you’ll attend a number of follow-ups at GenesisCare until any skin side effects have settled. You’ll also have a consultation four to six weeks after the completion your treatment or as needed, and then three, six and 12 months after.

Side effects

With VMAT, you may experience fewer side effects than with traditional radiotherapy. However, as with all treatments, there are side effects that you may experience.

Your doctor will explain about the potential side effects and how to manage them.

During treatment, your radiographers will be available to provide more advice about side effects , including what can help improve them and anything to avoid. It’s also important that you attend your follow-up appointments so we can identify and treat any problems as soon as possible.

Common short-term side effects that occur in the treatment area include:

  • Skin soreness
  • Skin breakdown (oozing and scabbing)
  • Hair loss
  • Swelling
  • Pain

You may also experience mucosal soreness if you’re being treated near your eyes, nose or mouth. This might include dry eyes, an inflamed and sore nose, or dry lips and mouth and mouth ulcers.

You may notice that the appearance of your skin will get worse before it gets better, but this is part of the normal healing process.

Common long-term side effects occurring in the treatment area include:

  • Permanent skin changes (texture and colour)
  • Telangiectasia (formation of small but prominent blood vessels)
  • Subcutaneous fibrosis (thickening of tissue)
  • Hair loss

Rarely, complications can occur which may include:

  • Lymphoedema – the swelling of bodily tissues, although the risk of this happening is lower than for other cancer types and the VMAT technique reduces this risk further
  • Second cancer – while there is a theoretical risk of developing a cancer in the skin around the treated area, the risk is very small. Your consultant will be available to answer any of your concerns
  • Non-healing ulcer
  • Permanent bone or cartilage damage
  • Cataracts

Book an appointment

Contact us today to find out if VMAT for skin cancerisation is right for you.
Enquire now

Frequently asked questions

External beam radiotherapy doesn’t make you radioactive. It’s perfectly safe for you to be with other people, including children and pregnant women, throughout your treatment.

We advise that you eat a normal, healthy, balanced diet during your treatment and drink more fluids than normal to keep you hydrated.

Wherever possible, wear loose fitting clothing made of natural fibres such as cotton or silk over the treatment area. This will help to reduce irritation.

You’ll be able to swim during the early stages of your treatment but you should wash your skin well after swimming. If your skin starts to have a reaction, you should talk to your radiotherapy team. We advise you not to swim for extensive periods and avoid taking long baths to help protect your skin which may become red or sore during treatment.

Over the course of your treatment, you may find that your skin becomes red, sore and itchy. It may even break in some areas.

Your treatment team will be checking your skin each day and you’ll have a more in-depth assessment with your care team once or more a week if required. By following the care advice provided, you can help prevent skin reactions from worsening.

Depending on your treatment site, you may have a gap during your treatment to allow your skin to recover.

After your treatment course, it should take around two to four weeks for the redness and soreness to heal.

 

DO’sDON’T’s
·        Wear loose clothing and natural fibres such as cotton

·        Protect skin from sunlight and wind

·        Gently clean the skin with warm water and a mild, unscented soap; rinse well and pat dry gently

·        Take short, lukewarm or cool baths and showers

·        Take short saltwater baths if the skin is itchy

·        Moisturise the skin in the treatment area using a water-based moisturiser recommended by the treating team twice a day

·        Keep the moisturiser in the fridge to help soothe the skin increase comfort

·        Speak with a member of the treatment team if the skin is broken or has moist areas

·        Talk to a member of the treating team if you’re not sure whether it is safe to use a certain product

 

·        Wear tight clothing which may increase irritation in the treatment area

·        Wear jewellery (including piercings) in the treatment area

·        Scratch the treatment area

·        Rub the skin after bathing

·        Use wet shaving, wax or hair removal creams within the treatment field (an electric razor is a safe alternative)

·        Use petroleum jelly-based products (hydrophobic/ water repelling)

·        Use products containing alcohol, perfumes, additives and products containing alpha hydroxy acids (AHA’s)

·        Use corn starch, talcum powder or baby powder

·        Use cold/heat packs or electric blankets in the treatment area

 

Although more uncommon, long-term side effects can occur as a side effect of radiotherapy to the skin. These include:

  • Permanent skin changes (texture and colour)
  • Telangiectasia (formation of small but prominent blood vessels)
  • Subcutaneous fibrosis (thickening of tissue)
  • Hair loss

Avoid exposing the area receiving radiotherapy to the sun during treatment and until all skin reactions have gone. Please don’t use any sun protection cream during your radiotherapy treatment. Instead, it’s better to protect your skin by staying in the shade and covering up with appropriate clothing and headwear. Your skin in and around the area that has been treated will always be more sensitive to the sun.

Once your treatment has finished and the side effects have settled, you should always protect the treated area by using at least SPF 50 sun cream.

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Cromwell Hospital

164-178 Cromwell Rd, Kensington, London SW5 0TU, UK

+44 (0)203 613 9355

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