Edema management with compression therapy during volumetric modulated arc therapy for extensive skin field cancerisation - a case study

Abstract

Non-melanoma skin cancer is the most frequently diagnosed cancer in Australia. Recent advances in radiation therapy (RT) allow large convex areas with extensive skin field cancerisation (ESFC) to be treated using volumetric modulated arc therapy (VMAT). RT doses and volumes are planned by radiation oncologists from pre-treatment computed tomography (CT) scans. Changes in limb volume due to the inflammatory response triggered by radiation can affect planned volumes and result in inaccuracies in dosimetry. We present a case study comparing outcomes with and without compression therapy following wide field VMAT to bilateral lower limbs. As edema can affect dosimetry, we hypothesized that edema management using compression therapy would be beneficial in controlling acute edema during RT. In this case when compression was applied during RT, treatment was able to be completed as planned in comparison to RT without compression where additional breaks in treatment were required due to edema and pain. There has been little published research examining edema management during RT for wide field skin cancerisation, however this case suggests further investigation is warranted to examine the potential value of compression therapy and accurate objective measures during VMAT for ESFC.