Experiences in growing a skin radiation therapy practice

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.