Patients With Nonmelanoma Skin Cancer Prefer RSCT Over Surgery

Rhenium-188 skin cancer therapy (RSCT) is a promising alternative to surgery in non-melanoma skin cancer (NMSC) as it reportedly causes less pain and produces similar aesthetic results, according to a recent study published in Healthcare.¹

Non-melanoma Skin Cancer Lesion Surgical Removal Close Up | image credit: Kate - stock.adobe.com

An estimated 20% Americans develop some form of skin cancer in their life, making skin cancer the most frequently occurring cancer throughout the US.² An approximated 9500 people are thought to be diagnosed with skin cancer each day in the US and NMSCs, such as cutaneous squamous cell carcinoma (CSCC) and basal cell carcinoma (BCC), impact over 3 million Americans annually.

NMSC accounts for a third of observed malignancies in humans and are the most prevalent tumor type among the light-skinned population.¹ Currently, Mohs surgery to address cancerous lesions is the typical treatment offered to patients; however, there is a considerable amount of pain associated with these procedures and concerns about the aesthetic results if tumors found on areas like the nose, ear, 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 wrote, adding that patients often receive a one-time treatment by applying a topical paste: Re-188-resin. They go on to cite a prior study of theirs that demonstrated that the efficacy of RSCT is on par with Mohs surgery, yet this treatment option is still not widely available and is only offered in a few centers globally.

To better explore and compare patient perceptions of both treatments, researchers conducted this follow-up study with patients with BCC or CSCC that was previously treated with RSCT in the author’s previously conducted rhenium-188 resin treatment study.

Eligible patients were interviewed between November 2020 and June 2023. This group consisted of 22 patients, 19 of which had undergone RSCT, and 3 had surgery alone. Sixteen of the 19 RSCT-treated patients had also had surgery either before or after the administration of RSCT. In the author’s previous study, follow-up was conducted at 14 days, 4 months, and 12 months—in the current evaluation, patients were asked to recount their side effects at these points in time. A questionnaire was also administered that was made up of 22 broad and treatment-specific questions; all patients were asked which treatment they would prefer should they develop another NMSC.

On average, patients were aged 83 years; nearly 66% had endured a BCC and almost 16% had endured a CSCC. The authors noted that half of their participants underwent surgery in the months after the study for a new NMSC, and half underwent procedures for an NMSC in the months before the study occurred. RSCT took place at a median of 5.3 months after surgery.

The majority of patients admitted to participating in the rhenium-188 resin treatment study because they wanted to avoid any complications or pain typically associated with surgery (84%). On a scale of 0-10 (0 indicating no fear, 10 indicating maximum fear), patients reported way less fear of RSCT than surgery (mean of 1.81 vs 2.97). As it pertained to treatment-related complications, over 44% of patients reported fear prior to their surgery compared with 28% leading up to RSCT (mean 2.28 vs 1.11; P = .04).

Little pain was reported throughout the group; however, patients reported experiencing significantly less pain in RSCT compared 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.

The 16 patients who experienced both treatments were asked about their preferences if another NMSC develops. Responses demonstrated that 44% would go the route of RSCT, 31% would consider either and lean on the advice of their physician, 19% would chose surgery, and 6% would forego any treatment whatsoever.

As the authors conclude, they emphasize that RSCT caused significantly less pain than surgery—in part because no local anesthesia is necessary for this treatment. Considering the comparable and favorable outcomes associated with RSCT, making this treatment more widely available could help alleviate treatment-related fears in patients and lead to less delays in patients’ care-seeking.

References

1. Krönert MIC, Schwarzenböck SM, Kurth J, et al. Patient-orientated evaluation of treatment of non-melanoma skin cancer with rhenium-188 compared to surgery. Healthcare (Basel). 2024;12(9):921. doi:10.3390/healthcare12090921

2. Skin Cancer. American Academy of Dermatology. Updated April 22, 2022. Accessed May 10, 2024. https://www.aad.org/media/stats-skin-cancer#:~:text=It%20is%20estimated%20that%20approximately,with%20skin%20cancer%20every%20day.&text=Research%20estimates%20that%20nonmelanoma%20skin,3%20million%20Americans%20a%20year.