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    Electronic brachytherapy allows collaboration between dermatologists, radiation oncologists

    National report — Electronic surface brachytherapy allows dermatologists to offer patients another safe, effective option for nonmelanoma skin cancer (NMSC), many experts say. And if the specialty doesn’t seize the opportunity, they add, it might lose some skin cancer treatments to radiation oncologists.

    Dr. Werschler“The appeal of electronic surface brachytherapy to the dermatology community is that this is something performed in our offices that has a cure rate, as best we understand it, that approximates that of Mohs surgery,” says Wm. Philip Werschler, M.D., a dermatologist in Spokane, Washington, and assistant clinical professor of medicine/dermatology, University of Washington School of Medicine, Seattle.

    Electronic surface brachytherapy is also patient- and physician-friendly, he says. Under the protocol approved by the Food and Drug Administration in 2009, electronic surface brachytherapy requires two treatments weekly for four weeks, versus 25 to 40 treatments total (three to five treatments weekly) with traditional radiotherapy, says Dr. Werschler, who offers electronic surface brachytherapy for NMSC in his office.

    Traditional radiotherapy also suffers from an image problem with respect to NMSC, he says. Along with the inconvenience of visiting a cancer center for months on end, “Patients with skin cancer don’t see themselves as being sick. They’re not losing hair or weight like patients with lung cancer or breast cancer.”

    Therefore, although traditional radiotherapy is effective for NMSC, patient acceptance proved problematic.

    Traditional radiotherapy uses large linear accelerators to generate radiation, so it requires a lead-lined fault and heavy shielding for patients during treatment, says Jonathan Baron, M.D., a dermatologist and Mohs surgeon in private practice in Santa Ana, California. He offers electronic surface brachytherapy for NMSC.

    Greater convenience

    Electronic surface brachytherapy uses a portable machine (Xoft Axxent Electronic Brachytherapy System; iCAD) about the size of a laser to generate radiation that physicians apply through an applicator placed directly on the skin. Each treatment takes about three minutes — the same amount of time as traditional radiotherapy, but with much less shielding required, Dr. Werschler says.

    Electronic surface brachytherapy uses a portable machine (Xoft Axxent Electronic Brachytherapy System; iCAD) about the size of a laser to generate precise, accurately targeted doses of radiation applied through an applicator placed directly on the skin. (Photos: Philip Werschler, M.D.)With the new technology, “We are able to deliver precise, accurately targeted doses with little if any excess radiation delivered to the surrounding skin,” Dr. Baron says. “And because radiation oncologists are truly the experts in utilizing radiation to treat all forms of cancer, we rely on them to come up with the appropriate treatment regimen for each patient. It truly is a collaboration between the dermatologist and the radiation oncologist.”

    The dermatologist biopsies the lesion and educates the patient about treatment options, Dr. Werschler says.

    “If the patient chooses brachytherapy or wishes to learn more about it, the patient meets with a radiation oncologist,” who ultimately oversees the treatments, which are performed by a radiation therapist (using doses calculated by an off-site medical physicist) in the dermatologist’s office, he says.

    “The procedure is noninvasive and painless, and clinically proven to be effective,” says Ken Ferry, president and CEO of iCAD. “The mobile design of the system allows dermatologists to offer this unique treatment option to a broader patient population and position their practice as an innovative leader in their community.”

    Most dermatology practices offering this procedure have a radiation oncologist on-site two days weekly, performing consultations and monitoring treatment, according to Dr. Baron.

    “Patients have a comfort level with that, because they’re familiar with your office, and they know the staff and how to get here. We used to have to send these patients to the hospital for treatment,” he says.

    Next: Quick treatments

     

    John Jesitus
    John Jesitus is a medical writer based in Westminster, CO.

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