The impact of anal VMAT on radiotherapy skin reactions

Abstract

Purpose or Objective The management of acute radiotherapy skin reactions in anal cancer patients is complex due to the location of the treatment area, its associated pain and potential risk for skin breakdown, which can ultimately lead to infection. Depending on the severity of their symptoms, patients may require admission to hospital for antibiotics and optimisation of their analgesia. Evidence has demonstrated that VMAT delivers improved radiotherapy skin reaction compared to conventional radiotherapy such as parallel opposed pairs or 4-field “brick” techniques. Alongside patient morbidity, use of VMAT should generate financial gains by reducing the need for dressings, analgesia and hospital admissions. Due to the relative novelty of VMAT, the information provided to patients does not always reflect these changes. This study aimed to inform patient information resources by evaluating the specific impact of VMAT on RTOG acute skin reaction grade of anal radiotherapy skin reactions and the rates of supportive care, hospital admissions and concordance to complete the prescribed treatment. Materials and Methods Patients were identified using the anal cancer database. Data from routine on-treatment review clinics and notes were retrieved for matched groups of 31 anal cancer radiotherapy patients who had received either standard radiotherapy or VMAT. Data collection included RTOG acute skin reaction grading along with the incidence of supportive care interventions including analgesia prescribing, tissue viability interventions and antibiotic prescriptions for all patients. A two-sample proportion test was performed to compare RTOG acute skin reaction grading and incidence of dressing usage, prescriptions and admissions between the cohorts. Results Data from 62 patients was passed for analysis and demographics for the two groups were matched well. Only one patient failed to complete the course of treatment; this was in the “standard” cohort due to their acute skin reaction. There were statistically significant differences in most metrics as seen in Table 1; these all favoured VMAT. Skin reactions were significantly improved for the VMAT cohort with RTOG grade 3 incidence 6/31 compared to 15/31 for standard (p=0.01552). Dressing rates were also reduced for VMAT patients 5/31, compared to 20/31 (standard). Similar reductions were seen with both analgesic and antibiotic prescriptions and admission rates.Conclusion Anal VMAT results in reduced skin reactions and intervention rates. A reduction in skin reactions is beneficial for patient experience but also financially beneficial for public hospitals with a reduction in hospital admissions and improved health economics due to a reduction in both analgesic and antibiotic prescription. The reduced incidence of severe skin reaction and likelihood of hospital admission should be included in patient information resources. The impact of VMAT on the incidence of radiation induced late effect skin reactions in anal cancer patients should be reviewed.