To the Editor: We congratulate Morton and colleagues1 on publishing data on volumetric modulated arc therapy (VMAT) in skin field cancerisation. In their case study, at 3.5 years after VMAT of bilateral arms, the number of new cancers arising in VMAT areas seems higher than non‐VMAT areas. The patient had required hundreds of treatments of many types for individual lesions before VMAT and was moving into wider field treatments as the disease became more aggressive. With the failure of all these treatments to provide long term control of his skin cancers, now systemic therapy warrants consideration.
- 1. Morton SK, Ozluer S, Muir J. Field cancerisation and radiotherapy: a case of treatment complications. Med J Aust 2023; 219: 12‐14. https://www.mja.com.au/journal/2023/219/1/field‐cancerisation‐and‐radiotherapy‐case‐treatment‐complications
- 2. Potter AE, Baker C, Shumack S, et al; National Dermatology Radiation Oncology Registry (NDROR) investigators and sites. Preliminary efficacy and safety analysis: 12‐month results in 83 patients using a novel approach of widefield radiation therapy for extensive skin field cancerization with or without keratinocyte cancers. J Dermatolog Treat 2022; 33: 2634‐2642.
- 3. Fogarty GB, Young S, Lo S, O'Toole J, Wanklyn M, Wong D, Sinclair S, Gottschalk G, Guitera P, Shumack S. (2021). Field‐based radiotherapy using volumetric modulated arc therapy (VMAT) for skin field cancerisation (SFC) — outcomes from 100 consecutive fields. Int J Radiol Radiat Ther 2021; 8: 13‐24.
- 4. Jansen MHE, Kessels JPHM, Nelemans PJ, et al. Randomized trial of four treatment approaches for actinic keratosis. N Engl J Med 2019; 380: 935‐946.
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