Rhenium-SCT® for Treatment of Skin Cancer
An option for some non-melanoma skin cancers
At UCLH, we have been working towards offering patients with non-melanoma skin cancer (NMSC) the option of having treatment with Rhenium-SCT. We have the framework in place to be able to offer this treatment to self-paying private patients, but I’m keen to hear from people with experience of this treatment about how they select patients for Rhenium-SCT, and how they counsel patients in the absence of long-term follow-up data.
On the surface, the advantages of topical rhenium-188 therapy appear obvious – most notably the treatment in a single visit and promising cosmetic outcomes - and it will undoubtedly find its place in the arsenal of strategies we employ to treat NMSC. But the gold standard remains Moh’s surgery while we discuss the level of evidence we need to recommend this treatment and work out how we select the patients so that they experience optimal treatment outcomes - be that Moh’s, external beam radiotherapy, or Rhenium-SCT. I welcome insights from, and collaborative discussions with, experts in this field.
Skin cancer, a growing concern globally, demands innovative approaches. Surgical interventions, while most effective, may pose cosmetic challenges. A study led by Professor Julia Tietze found that topical rhenium-188 had:
· Impressive response rate: 97.5% at 12 months, with 95.0% complete responses.
· Minimal adverse events: No complications during treatment application, with manageable post-treatment effects such as itching or minor pain.
· Promising cosmetic outcomes: 41% of lesions graded as cosmetically superior or aesthetically appealing, despite some hypopigmentation.
https://pubmed.ncbi.nlm.nih.gov/37682602/
While these results are promising, questions arise: How do we guide patients in choosing between the current gold-standard surgery and emerging therapies like rhenium-188? What level of evidence do we need to confidently recommend one treatment over another?
At UCLH, we are proud to have this as a treatment option for some patients once we’re confident it is the correct option. However, it's crucial to counsel patients appropriately about this new treatment, which lacks long-term follow-up data. We must also work collaboratively across the multidisciplinary team to help patients access the best advice and information to help them make the best treatment decision.
How is Rhenium-SCT given?
The Rhenium SCT treatment is applied in an outpatient visit. This therapy involves a single application and utilises a paste, which is applied during your visit to the outpatient department of the hospital.
During the procedure, we will cover the targeted cancerous area with a thin foil before applying the Rhenium-SCT paste onto the foil. Depending on the location of your cancer, you may be asked to either lie down or sit up to ensure comfort throughout the treatment. It is crucial that you avoid touching the treatment area while the paste is active, which can range from a few minutes to up to three hours, though typically the process lasts about one hour.
Post-treatment, there is no residual radioactivity on your skin, as the paste never directly contacts it. There is also no ongoing radiation emitted from the treated area after the procedure is complete. You can safely leave the hospital immediately following the treatment. I will provide you with guidance on how to care for the area that was treated.
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