ABSTRACT
The purpose of this chapter is to pass on some experience our multidisciplinary team has acquired in combining radiotherapy (RT) and systemic treatments for patients with keratinocyte carcinomas (KC) and Merkel cell carcinoma (MCC) to assist in the management of these cases. Specifically, this chapter reviews the impact of systemic treatment in KC and MCC when receiving radical RT. Three scenarios are described – (1) when a systemic treatment is given concurrently to increase the efficacy of the RT, (2) when a patient is receiving RT for skin but is also receiving systemic treatment for a different cancer and (3) when a patient is receiving RT for skin and is also on systemic treatment for non-cancer conditions. Defining the goal of therapy as either radical or palliative intent is important at the outset to save unnecessary toxicity, disappointment and cost. The possibility of interaction of RT for skin cancer and systemic therapy requires the radiation oncologist to take a detailed medical history, especially previous and current medications and any issues with previous RT toxicity in the patient or the patient’s family. Communication with multidisciplinary colleagues in planning treatment and aftercare is crucial to achieving the best outcome.
