Presented by Dr. Michael Webster
Melbourne, Australia
Hot Spots in Dermatology
August 17, 2018

• What’s new?
• VMAT for treating large areas (whole arm,leg) for actinic keratoses/NMSC
• A treatment for Disseminated Actinic Porokeratosis ?
• VMAT
• Volumetric modulated arc therapy (Elektra)
• Delivers the radiotherapy treatment using a rotational or arc geometry rather than several static beams .
• Gantry motion,variable dose rate,movement of multileaf collimators
• Computerised planning using Ct scan allows treatment to be delivered to tumour with minimal exposure to adjacent tissues
• VMAT for skin

Can be set to give radiation just to skin &  subcutaneous tissue circumferentially (with minimal exposure to deeper tissues) allowing treatment of a whole limb ,scalp,or head & neck area.
Genesis Care  is trialling this Rx for treatment of NMSC & actinic keratoses over large areas
25 x 2Gy over 5 weeks

• Grenz ray for DSAP
• background
• Successful Use of Grenz rays for DSAP

E Rameltye et al Dermatology 2017;233:217-222
Retrospective study 8 pts age 54-84
7/8 complete clinical clearing
f/u 2-65/12 (median 21.4) 1pt had 1 relapse lesion (46/12)
Total dose per field 28-52 Gy. (4Gy fractions)
No NMSC in treated areas

• Grenz & DSAP
• Ricci C ,Rosset A,Panizzon RG Bullous&pruritic variant of DSAP:successful treatment with Grenz rays Dermatology 1999;199:328-331
• Case report no details of treatment
• Our experience
• 2 patients 6 x 4Gy both developed reactions –essentially clear –pts very happy