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How effective is radiation in controlling skin cancer metastatic to nodes?

A 2019/2020 Summer Studentship research project

To get a better understanding of the population of patients with skin cancer which spreads to the nodes and their patient journey. To study if patients receive appropriate referrals and treatment and whether the results of treatment are similar to results internationally.

Student: George McCook
Supervisors: Melissa James (radiation oncologist)
Sponsor: Canterbury Medical research Foundation

Introduction

Skin cancer is the most common cancer in New Zealand, comprising 80% of all new cancers each year. Skin cancers are most commonly early stage cancers and treated successfully with surgical excision. In some cases skin cancers can spread to lymph nodes. This can occur in melanoma and also non- melanoma skin cancer, especially squamous cell carcinoma. Most commonly patients with nodal spread of their skin cancer have the lymph nodes resected by surgery, but local recurrences may occur within the nodes and radiation treatment has been used to decrease the risk of relapse. A randomized trial in patients with high risk of regional recurrence after a lymph nodes dissection for melanoma found that those patients randomized to radiation rather than observation had less nodal field relapse but no improvement in overall survival. There is no randomized evidence in non-melanoma skin cancer, however some series have indicated improvements in local control and potentially overall survival. Radiation treatment may have benefits but also may have side effects thus it is important to have a good understanding of the benefits within our patient population. Other adjuvant therapies (such as immunotherapy for melanoma) have developed since these historical series have been published and surgical and radiation treatments have evolved, so there is a need for the reporting of a contemporary series. In the case of non-melanoma skin cancer the benefits of radiation are not well documented and hence this study aims to add to this limited body of evidence.

Aim

The aim of this project is to study the patterns of care of patients who develop nodal metastases from skin cancer in the CDHB over the last 10 years. We aim to study the demographics of the patient (age/gender), tumour characteristics), Multidisciplinary meeting discussions (MDM), treatments delivered (details of these) and outcomes (local control, overall survival, toxicity). We would then wish to compare outcomes with international standards published in the literature.

Method

I have already contacted decision support and we plan to use hospital diagnosis codes to identify patients with skin cancer which has spread to nodes, either at the time of presentation or later. Having identified patients we would use paper/ electronic records to determine the details stated in the aim, filling in a database of relevant information for these patients. This database would be double password protected and at the conclusion all patients would be identified. Statistical analysis of outcomes would then be performed using Kaplan Meier estimates.

Student researcher’s component of the study

The database would already have been developed for the student prior to them commencing the project, so the student’s main task would be to fill the data fields from the operation reports, pathology/ radiology reports, MDM discussions, radiation treatment information and follow-up data. The student would then be involved in the statistical analysis with the hospital statistician. The student would then be involved in presenting the findings to the oncology department and also writing up the project for a medical journal (most likely JMIRO)

References

  • (Adjuvant lymph-node field radiotherapy versus observation only in patients with melanoma at high risk of further lymph-node field relapse after lymphadenectomy (ANZMTG 01.02/TROG 02.01): 6-year follow-up of a phase 3, randomised controlled trial. AUHenderson MA, Burmeister BH, Ainslie J, Fisher R, Di Iulio J, Smithers BM, Hong A, Shannon K, Scolyer RA, Carruthers S, Coventry BJ, Babington S, Duprat J, Hoekstra HJ, Thompson JF SOLancet Oncol. 2015;16(9):1049)
  • Wang JT, Palme CE, Morgan GJ, Gebski V, Wang AY, Veness MJ. Head Neck 2012 Nov;34(11):1524-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22109745.
  • Fogarty GB, Christie D, Spelman LJ, Supranowicz MJ, Sinclair RS.. Can Modern Radiotherapy be used for Extensive Skin Field Cancerisation: An Update on Current Treatment Options. Biomed J Sci &Tech Res 2018;4(1).

Student Prerequisites

Most suited to a medical student.

How to apply

Email melissa.james@cdhb.health.nz