NMSC Skin Cancer: Rhenium-188 as Surgery Alternative

According to a recent study published in Healthcare, rhenium-188 skin cancer therapy (RSCT) is a possible substitute for surgery in non-melanoma skin cancer (NMSC) cases because it supposedly causes less discomfort and yields comparable cosmetic results. This finding is particularly relevant during Skin Cancer Awareness Month, as it highlights potential advancements in treatment options for this prevalent form of cancer.

Patients who have non-melanoma skin cancer chose rhenium-188 skin cancer therapy (RSCT) for surgery, according to a follow-up study that used survey responses and interviews.

Skin cancer is the most common cancer in the United States, with an estimated 20% of Americans developing skin cancer at some point in their lives.2. An estimated 9500 individuals in the United States are expected to receive a skin cancer diagnosis every day, while non-malignant skin cancers (NMSCs), including cutaneous squamous cell carcinoma (CSCC) and basal cell carcinoma (BCC), affect more than 3 million Americans each year.

Among those with light skin, non-malignant stem cells (NMSCs) are the most common type of tumor, making up one-third of all human malignancies that have been seen.1. The standard treatment currently provided to patients for malignant lesions is Mohs surgery; however, this process is quite painful, and there are worries over the cosmetic outcome if the tumors are located in places such as the nose, ears, etc.

RSCT, a high-dose brachytherapy, has emerged as a viable treatment option for NMSC. “Rhenium-188 is a high-energy beta-emitting therapeutic radioisotope, which destroys the tumor cell up to 3 mm in depth and leads to activation of the immune system,” The authors noted that Re-188-resin is a topical paste that is commonly applied as a one-time treatment to patients. They continue by citing a previous study of theirs that showed RSCT’s effectiveness to be comparable to that of Mohs surgery; nevertheless, this treatment option is still not generally accessible and is only provided in a few locations worldwide.

Researchers performed this follow-up study with patients with BCC or CSCC who had previously received RSCT in the author’s prior rhenium-188 resin therapy trial to more thoroughly examine and evaluate patient perceptions of both treatments.

Interviews with qualified patients took place from November 2020 to June 2023. There were 22 patients in this group; 3 had only surgery, and 19 had received RSCT. Of the 19 patients treated with RSCT, 16 had undergone surgery, either before or following RSCT administration. Patients were asked to recollect their side effects at 14 days, 4 months, and 12 months in the current evaluation, as they were in the author’s prior study.

In addition, a questionnaire consisting of 22 general and therapy-specific questions was given to each patient, asking them to select a different course of treatment if they developed another NMSC.

Patients were 83 years old on average; almost 16% had experienced a CSCC and nearly 66% had experienced a BCC. According to the authors, half of the patients had surgery for a new NMSC in the months following the study, and the other half had NMSC operations performed in the months before the study. RSCT was performed, on average, 5.3 months following surgery.

Eighty-four percent of the participants said they were drawn to the rhenium-188 resin treatment research because they wished to avoid the pain and risks that come with surgery. Compared to surgery, patients expressed much less fear of radiation therapy (mean of 1.81 vs 2.97), on a scale of 0–10 (0 representing no fear, 10 representing greatest fear). Regarding treatment-related problems, more than 44% of patients expressed worry before surgery, whereas 28% did so before RSCT (mean 2.28 vs 1.11; P =.04).

While the sample as a whole experienced minimal pain, patients reported much less pain with RSCT than with surgery (mean of 0.56 vs 2.32; P =.02). Pain reports at 4-month and 12-month follow-up were not significantly different, but at 14-day follow-up, patients were experiencing significantly more pain after surgery than RSCT (mean of 2.47 vs 0.89; P = .02). At 14 days, surgery-treated lesions were also significantly itchier than RSCT-treated lesions (mean of 1.50 vs 0.37; P = .02). Reports of burning sensations did not differ between treatment experiences.

Aesthetic evaluations of lesions post-treatment revealed that the majority of patients were pleased with the outcome, rating their aesthetic outcomes between 8 and 10.

When asked what they would want to see if another NMSC developed, the 16 patients who underwent both treatments responded. According to the responses, 44% would choose RSCT, 31% would think about both and rely on their doctor’s recommendation, 19% would choose surgery, and 6% would forgo any kind of treatment at all.

The authors stress in their conclusion that RSCT was far less painful than surgery, in part because a local anesthetic is not required for this procedure. Expanding access to RSCT could help patients overcome treatment-related anxiety and reduce the number of delays in seeking therapy, given the similar and positive results linked with this treatment.

For more information: Patient-Orientated Evaluation of Treatment of Non-Melanoma Skin Cancer with Rhenium-188 Compared to Surgery, Healthcare, https://doi.org/10.3390/healthcare12090921