Interventional procedure overview of epidermal radiotherapy using rhenium-188 paste for non-melanoma skin cancer
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Evidence summary
Population and studies description
This interventional procedures overview is based on publications reporting on the safety and efficacy outcomes of approximately 218 people with NMSC from 1 single-arm trial (Castellucci, 2021) and 5 case series (Carrozzo, 2013; Carrozzo, 2014; Cipriani, 2017; Cipriani, 2022; Sedda, 2008). Additional safety outcomes from 22 people with NMSC reported in 1 conference abstract were also included. All patients had the procedure. This is a rapid review of the literature, and a flow chart of the complete selection process is shown in figure 1. This overview presents 6 published studies and 1 abstract as the key evidence in table 2 and table 3.
The single-arm trial was the only prospective study (Castellucci, 2021). All 6 key studies were done in Italy. Of the key studies, 4 included people from the same hospital. Not all studies reported the dates that participants had treatment. All key studies included at least one author that co-authored at least one other publication included in this overview. There may be some overlap in participants included in these studies.
The mean age of people with NMSC considered for efficacy outcomes was between 66 and 81; 2 of the published studies and the conference abstract did not report the ages of participants in their study (Cipriani, 2017; Schwarzenbock, 2022; Sedda, 2008). Follow up was a mean of 20 months (range: 3 to 33 months) in the one prospective study (Castellucci 2021). Among the case series, mean follow-up was between 288 days (approximately 9.5 months) and 51 months. Follow-up was 12 months in the conference abstract (Schwarzenbock, 2022). It was unclear whether the reported follow up points were after the last treatment received or if further treatment sessions were done during follow-up in some studies.
Whether lesions had been previously treated, which therapies were applied to lesions if previously treated and the type and size of lesions treated with rhenium-188 paste varied between and within studies. The most common type of lesion was BCC but most studies also included SCCs and sometimes EMPD and Bowen's disease. One study only included people with EMPD (Carrozzo, 2014) and one study only included people with SCC (Carrozzo, 2013). Most studies included some people with lesions that were previously treated with another intervention. Most studies included lesions located anywhere on the body but most were on the head and neck. Two studies only included people with lesions on the genitalia (Carrozzo, 2013; Carrozzo, 2014). Across studies, average lesion size was between 3 and 10 cm2 but ranged from 0.3 to 65 cm2. Lesion depth was between 0.1 to 2.5 mm across studies. Two studies did not report the size or depth of lesions.
In the single-arm trial, 18 out of 60 lesions had already been treated with other therapies and relapsed (5 lesions had previous surgery; 2 lesions had previous surgery and photodynamic therapy or cryotherapy; 10 lesions had previous cryotherapy, laser and photodynamic therapy; 1 lesion had previous imiquimod) while 42 lesions were new diagnoses at presentation. In this study, 68% of lesions were BCCs, 30% were SCCs and 1 lesion was BCC and SCC. Lesions were mostly on the face, ears, nose and scalp (77%) and the remaining on extremities (15%) and trunk (8%). The mean surface area of lesions was 7 cm2 (1 to 36 cm2) and the mean depth was 1.1 mm (0.2 to 2.5 mm). This was not the largest lesion size among the studies (based on the mean lesion size and the maximum lesion size included) but they did treat the deepest lesions compared to other studies. The authors suggested that the size of lesions treated in their study may explain some of their grade 3 side-effects.
In the case series of 53 people, 28% of lesions had previous surgical treatment (Sedda, 2008). Lesions were diagnosed as BCC (70%) and SCC (30%) and mostly on the head and neck (70%). Other lesions were on the upper and lower limbs (22%) and trunk and back (8%). The mean size of lesion was 7 cm2 (SD=8.9). The depth of lesions was not reported.
In the case series of 52 people, 54% of lesions had previous surgery or other intervention (Cipriani, 2022). Most lesions were BCCs (58%) but SCCs (35%) and 4 lesions diagnosed as Bowen's disease (n=2) and EMPD (n=2) were also treated. Most commonly, lesions were on the head and neck (73%) or genitalia (15%). Average lesion size was 10 cm2 (range between 0.3 and 61 cm2) and depth was between 0.3 and 0.6 mm.
In the case series of 43 people, 26% had previous surgery (Cipriani, 2017). Lesions were mostly BCCs (67%) and the rest were SCCs. Lesions were mostly located on the head and neck (65%) but lesions on the back, arm, leg, and penis were also treated. Median lesion size was 3 cm2 (range 1 to 49 cm2). Two lesions were deeper than 0.5 mm.
All participants in the case series of 15 people (Carrozzo, 2013) had previous topical therapy for SCC lesions located on the penis. One lesion was also previously treated with imiquimod and 5-fluorouracil and 2 with surgery. The size of lesions treated in this study was not reported.
In the case series of 5 people (Carrozzo, 2014), 80% of the participants had previous topical treatments for lesions. All 5 lesions were EMPD located on the genitalia. The size of lesions was not reported.
In the abstract reporting a case series of 22 people (Schwarzenbock, 2022), 58% of lesions were BCC, 30% were Bowen's disease and 13% were SCC. Average lesion size was 3 cm2 (range 0.5 to 20 cm2). Lesion depth ranged from 0.1 to 2.1 mm. This study did not report on previous treatment of the lesions.
Table 2 presents study details.
First author, date country | Patients (male: female) | Age | Study design | Inclusion criteria | Intervention | Follow up | |
|---|---|---|---|---|---|---|---|
1 | Castellucci, 2021, Italy | n=50 (70% male, 30% female) 60 histologically proven NMSCs (n=41 BCC; n=18 SCC; n=1 BCC and SCC) | Mean=81 | Single-arm trial October 2017 to January 2020 | 1) histologically proven BCC or SCC; (2) lesion thickness invasion less than 2.5 mm; (3) lesions located in the scalp, face, ears, or fingers or other areas in which surgery, EBRT or standard brachytherapy would have been difficult; (4) contraindication or refusal of surgery | Rhenium-188 brachytherapy using Rhenium-SCT (Oncobeta GmbH, Germany) Results were evaluated after 1 treatment session. | Mean 20 months (range 3 to 33) |
2 | Sedda, 2008, Italy | n=53 (55% male, 45% female) n=37 BCC; n=16 SCC n=9 had multiple BCCs; n=3 had multiple SCCs | Not reported | Case series | Histologically confirmed BCC or SCC; relapse of tumour or surgery considered impossible or aesthetically unacceptable. | Rhenium-188 brachytherapy 43 people had 1 treatment session, 8 people had 2 and 2 people had 3 treatment sessions. | Mean 51 months (range 20 to 72) |
3 | Cipriani, 2022, Italy | n=52 (65% male, 35% female) n=55 lesions which included n=32 BCC, 2 SCC, 2 Bowen's disease, 2 EMPD | Mean=71.7 | Retrospective case series 2005 to 2014 | Histologically confirmed BCC, SCC, Bowen's disease or EMPD | Rhenium-188 brachytherapy using Rhenium-SCT Results were evaluated after 1 session. | Mean=414 days; Median= 296 days |
4 | Cipriani, 2017, Italy | Unclear; n=42, 43 and 44 reported in different parts of the full-text (approximately 58% male, 42% female) n=87 histologically confirmed lesions including BCC and SCC. N=1 patient had Bowen's disease. | Not reported | Retrospective case series | Histologically confirmed NMSC; complete histological record, dosimetry information and imaging material | Rhenium-188 brachytherapy Fractionated treatment was planned for people with lesions on lips and genitalia across 2 or 3 sessions. Otherwise responses reported after 1 session. | Mean 288 days (range 35 to 1,150 days) |
5 | Carrozzo, 2013, Italy | n=15 (100% male) | Mean= 66 | Case series June 2005 to April 2010 | Confirmed diagnosis of SCC of penis | Rhenium-188 brachytherapy using Rhenium-SCT (ITM, Germany) Up to 7 sessions. Some people had multiple sessions to treat different lesions. | Mean 51 months (range 12 to 84 months) |
6 | Carrozzo, 2014, Italy | n=5 (20% male; 80% female) 80% primary EMPD; 20% secondary | Mean=69 | Case series First treatment sessions were between 2008 and 2010 | Clinical diagnosis of EMPD | Rhenium-188 brachytherapy using Rhenium-SCT (ITM, Germany) 1 session unless relapsed. | Mean 34 months (range 27 to 48) |
7 | Schwarzenbock, 2022, Germany | n=22 n=37 lesions (n=23 BCC, 12 Bowen's disease, 5 SCC) | Not reported | Conference abstract reporting case series | Histologically confirmed NMSC | Rhenium-188 brachytherapy using Rhenium-SCT Results reported after 1 session. | Up to 12 months |
Table 3 Study outcomes
Efficacy outcomes | Safety outcomes | |
|---|---|---|
Castellucci, 2021 | Complete response at 6 months=98% (53/54 evaluable lesions; total sample included 60 lesions) Partial response in 1/54 lesions (there was a small residual lesion, which was surgically excised with good cosmetic results). Lesions free from relapse at 12 months=100% (41/41 evaluable lesions) Lesions free from relapse at 24 months=96% (23/24 evaluable lesions) 1 lesion required retreatment within 24 months. Cosmetic results 12 to 33 months after 1 session
| No notable pain during or after treatment. 93% (56/60) of lesions showed early localised side-effects (grades 1 to 2) including skin erythema, faint or moderate oedema and ulcerations. These resolved in a mean of 4 weeks. 7% (4/60) of lesions showed more severe (grade 3) early side effects which resolved within 90 days (mean=10 weeks). Late side effects (3 to 33 months) included dyschromia, slight skin atrophy, hair loss. These were not considered significant. |
Sedda, 2008 | Complete clinical remission= 100% (53/53) 3 to 5 months after treatment (43 people had 1 treatment session, 8 people had 2 and 2 people had 3 treatment sessions) There were no relapses within 20 to 72 month follow up. Complete healing= 100% (53/53) after 20 to 72 months (mean= 51 months) and up to 3 sessions. No disfiguring scarring. Histological analysis, available for about 60% of patients, confirmed complete tumour regression after the treatment (timing not reported). | Erythema in irradiated area which disappeared after 2 to 7 days. Bleeding in large lesions which stopped and formed a scab 10 to 30 days after treatment. No pain. No systemic or topical side-effects. No measurable radioactive contamination. No longer term side effects. |
Cipriani, 2022 | Complete remission= 100% (52/52) of people after 1 session. Remission was sustained throughout follow up (median= 296 days; 27% (14/52) people were lost to follow up and may not have been included in this figure). | 10% (5/52) died after 1 year of treatment. Cause of death was not reported. Slight depigmentation of the treated region. No other complications or post-interventional problems. No radioactivity contamination of patients, staff or equipment |
Cipriani, 2017 | Complete remission at follow up=100% (mean follow up 288 days (range 35 to 1,150 days, median 212 days; 1 person was lost to follow up). 5% (2/43) required unplanned retreatment because the security margin was too tight, resulting in a recurrence at the border of the treated area. All achieved full remission after this. Radiation wounds healed within 30 to 154 days (median=53 days). | Some lesions produced clear serum for 1 to 2 weeks after treatment but stopped without further intervention. No other side effects or adverse events during or between 30 and 154 days after treatment. No pain during or after treatment. No haematological toxicity observed. No radioactivity contamination. |
Carrozzo, 2013 | Complete remission at follow up=80% (12/15) (mean 51 months; 1 person lost to follow up). 13% (2/15) required surgical salvage therapy. | Faint redness in irradiated area immediately after treatment. Erythema present after a few days. Serum secretion which formed a crust. Visual clinical healing in 3 to 4 months. The authors report no pain, discomfort or other side effects. |
Carrozzo, 2014 | Complete remission at the end of treatment=100% (5/5) Of the 5 patients,1 had 1 treatment session and 4 had 2 sessions; 2 of the 5 patients had relapse inside the treated area and 2 had relapse at the periphery of the previously treated area. Clinical healing in a mean of 34 months. | Faint redness in irradiated area immediately after treatment. Burning sensation and superficial erosions in days after treatment requiring topical or analgesic treatment. Erythema Serum secretion from wound which formed a scab and resolved in 2 to 3 weeks. One patient, who had secondary EMPD, died from metastatic bladder cancer. |
Schwarzenbock, 2022 | Efficacy data is not extracted from conference abstracts. | Not otherwise reported Day 14 Most lesions increased in size up to 900% because of inflammation. Itching reported in 18% (7/40) Scaling in 8% (3/40) Mild pain in 13% (5/40) 4 months 8% (3/40) reported itching 5% (2/40) reported pain (these were people with persistent NMSC and ulceration) 12 months 48% (13/27) showed hypopigmentation 67% (18/27) showed mild scarring |
Procedure technique
Four studies and the conference abstract named the device used to apply rhenium-188 paste to the skin (Carrozzo, 2013; Carrozzo, 2014; Castellucci, 2021; Cipriani, 2022; Schwarzenbock, 2022). All used the Rhenium-SCT kit. This device contains the radioactive material in an applicator and has a shield to protect the person applying the substance to the skin. All treatments were done within a nuclear medicine department. Cipriani (2017) used a device that looks like this kit but did not name it. Sedda (2008) gave no information on device or application tool.
All studies used materials to prevent direct contact between the radioactive material and the skin. One study (Sedda, 2008) used protective cream, 4 studies used an adhesive plastic foil (Carrozzo, 2013; Carrozzo, 2014; Castellucci, 2021; Cipriani, 2017) and 1 study used the cream and/or the foil (Cipriani, 2022). The conference abstract did not report what method was used (Schwarzenbock, 2022).
All studies tailored the dose according to initial radioactivity, isotope emission energy, contact time and the size and depth of the lesion. All studies used at least one algorithm to calculate the dose required. Castellucci (2021) used a progressive reduction of delivered doses because of the incidence of early side-effects.
Studies applied the radioactive substance to an area which included the lesion and a border of healthy tissue. Carrozza (2013; 2014) used a margin of 2 to 4 mm. Cipriani (2017) used a margin of 3 to 5 mm. Castellucci (2021) used a margin of 3mm. Cipriani (2022) used a margin of 5 mm.
Irradiation time varied within and between studies. Sessions lasted between 15 minutes and 2 hours in Sedda (2008) and Cipriani (2017). Carrozzo (2013; 2014) both reported sessions lasted between 30 minutes and 1 hour. Castellucci (2021) reported sessions lasted between 21 and 285 minutes and Cipriani (2022) reported sessions lasted between 8 and 240 minutes. In the conference abstract, Schwarzenbock (2022) reported sessions lasted between 38 to 175 minutes.
The number of sessions and reasons for multiple sessions varied between studies. Details are presented under efficacy outcomes in terms of relapse and reintervention rates.
Efficacy
Complete remission
All 6 studies reported data on remission. Complete remission ranged from 80% to 100%.
In the single-arm trial of 50 people with 60 lesions, 54 lesions were followed up 6 months after 1 treatment session and 98% showed complete response to treatment (Castellucci, 2021). Partial response was observed in 1 lesion.
In the case series of 53 people, 100% (53/53) were in apparent complete clinical remission after 3 to 5 months (Sedda, 2008). 81% (43/53) were treated with 1 session, 15% (8/53) with 2 sessions and 4% (2/53) with 3 sessions.
In the case series of 52 people, 100% (52/52) showed complete remission after 1 session (Cipriani, 2022).
In the case series of 43 people, 100% (43/43) showed complete remission between 35 and 1,150 days after treatment (median=212 days; Cipriani, 2017). This included 2 people (5%) whose lesions needed unplanned retreatment because of recurrence at the border of the treated area.
In the case series of 15 people with SCC of the penis, complete remission was observed in 80% (12/15) of people, 13% (2/15) of lesions did not respond to therapy and 1 person was lost to follow-up (Carrozzo, 2013). Lesions were treated in up to 7 sessions and mean length of follow-up was 51 months.
In the case series of 5 people, all 5 showed complete remission after a mean follow up period of 34 months (Carrozzo, 2014). Lesions were treated with 1 session in 1 person, and with 2 sessions in 4 people. Retreatment was triggered by partial response in these 4 people.
Relapse
In the single-arm trial of 50 people including 60 lesions treated in 1 session, 100% of people who were followed up (41/41) were still in remission at 12 months (Castellucci, 2021) and 96% of those who were followed up (23/24) were still in remission at 24 months. One lesion needed retreatment by 24 month follow up.
In the case series of 53 people, there were no relapsed cases after 20 to 72 months (mean=51; Sedda, 2008). Lesions were treated in up to 3 sessions. The authors did not report whether additional sessions were planned or triggered by recurrence.
In the case series of 52 people, there were no relapsed cases after a median follow-up of 296 days (Cipriani, 2022). This figure may not include 14 patients that were lost to follow-up. They reported 10% (5/53) of people died after the first post-interventional year and reason for death was not reported.
In the case series of 43 people, fractionation of treatment across 2 or 3 sessions was planned for people with lesions on their lips or genitals. Further treatment was triggered in some cases by recurrence at follow up (Cipriani, 2017). They reported that 5% (2/43) of people needed unplanned retreatment with rhenium-188 paste. All had full remission after retreatment.
In the case series of 15 people with SCC of the penis, lesions were treated in up to 7 sessions (Carrozzo, 2013). It was unclear whether retreatment was triggered by partial response or recurrence which required further intervention or if this was planned. Some people with SCC of the penis were treated in different locations in different sessions. They reported that 13% (2/15) required surgical salvage therapy because of non-response. Results were reported at a mean follow-up of 51 months. One participant was lost to follow-up.
In the case series of 5 people, relapse triggered a second session of therapy in 4 of 5 people (Carrozzo, 2014). After retreatment, all 5 were in complete remission at a mean of 34 months follow-up.
Healing and cosmesis
In the single-arm trial of 50 people with 60 BCC and SCC lesions, Radiation Therapy Oncology Group criteria were used to evaluate cosmetic results 12 to 33 months after 1 session (Castellucci, 2021). Of 41 evaluable lesions (68% of original sample), 73% (30/41) were rated excellent and 27% (11/41) were rated good.
In the case series of 53 people, the authors reported no disfiguring scarring after 20 to 72 months (mean=51 months) and that all lesions had completely healed after up to 3 sessions (Sedda, 2008).
In the case series of 52 people with lesions treated in 1 session, slight depigmentation was observed (Cipriani, 2022).
In the case series of 43 people, radiation wounds were observed between 30 and 154 days after treatment (Cipriani, 2017). These healed without medical intervention. The authors reported that treatment leaves no scar but in some cases faint discolouration of the skin is present.
In the case series of 15 people with SCC of the penis, visual and clinical healing was reported 3 to 4 months after treatment (Carrozzo, 2013).
In the case series of 5 people, complete healing was observed after a mean of 34 months follow up (Carrozzo, 2014).
Safety
In the single-arm trial of 50 people with 60 BCC and SCC lesions, Common Terminology Criteria for Adverse Events (5.0) was used to assess early skin toxicity within the first 30 days of 1 session of treatment in all 60 lesions (Castellucci, 2021). 93% (56/60) showed early side-effects (grades 1 to 2) including erythema, faint or moderate oedemaandulcerations. These resolved in a mean of 4 weeks. 7% (4/60) lesions showed more severe (grade 3) early side effects which resolved within 90 days (mean=10 weeks). No notable pain was reported during or after treatment. Late side-effects (3 to 33 months) included dyschromia, slight skin atrophy, hair loss. The authors did not consider these to be significant side-effects.
In the case series of 53 people, erythema was reported in the irradiated area which disappeared after 2 to 7 days (Sedda, 2008). Bleeding was reported in large lesions which stopped and formed a scab 10 to 30 days after treatment. No pain, systemic or topical side-effects, measurable contamination or other longer-term side effects were reported.
In the case series of 52 people, the authors reported no other complications, post-interventional problems or contamination (Cipriani, 2022). They reported 9% (5/53) of people died after the first post-interventional year and reason for death was not reported.
In the case series of 43 people, the authors reported that some lesions produced clear serum for 1 to 2 weeks after treatment but stopped without further intervention (Cipriani, 2017). The authors reported that no pain, haematological toxicity, contamination or other side effects were observed during or after treatment.
In the case series of 15 people with SCC of the penis, faint redness in the irradiated area was observed immediately after treatment (Carrozzo, 2013). Erythema was present after a few days. There were 3 cases of serum secretion from the treated area which then formed a crust. The authors reported no pain, discomfort or other side effects.
In the case series of 5 people, there was faint redness in the irradiated area immediately after treatment (Carrozzo, 2014). The authors reported a burning sensation and superficial erosions in the days after treatment, requiring topical or analgesic treatment. Erythema was observed and some lesions secreted serum which later formed a scab.
Other adverse events were reported in the conference abstract. At day 14, Schwarzenbock (2022) reported up to 900% increase in lesion size because ofinflammation, itching in 18%, mild pain in 13% andscaling in 8%. At 4 months, 8% of participants reported itching and 5% reported pain. The people who reported pain had either persistent NMSC or ulceration of the lesion. At 12 months, 48% showed hypopigmentation and 67% showed mild scarring.
Anecdotal and theoretical adverse events
The authors of the single-arm trial (Castellucci et al, 2021) stated that a longer observation period is needed to rule out the theoretical possibility of developing another (secondary) cancer in the local skin due to the radiation treatment.
Expert advice was sought from consultants who have been nominated or ratified by their professional society or royal college. They were asked if they knew of any other adverse events for this procedure that they had heard about (anecdotal), which were not reported in the literature. They were also asked if they thought there were other adverse events that might possibly occur, even if they had never happened (theoretical).
They listed the following anecdotal and theoretical adverse events:
infection
skin burns
dry skin
alopecia
skin induration
hyperpigmentation
telangiectasia
secondary/ late malignancy in treated region (up to decades later)
delayed wound healing
unintended exposure to other parts of the body
keloids
necrosis.
Four professional expert questionnaires for this procedure were submitted. Find full details of what the professional experts said about the procedure in the specialist advice questionnaires for this procedure.
Validity and generalisability
The 6 studies included in the key evidence had a collective sample of 218 people. Each study had 53 participants or less.
All 6 key studies were done in Italy.
Complete response was between 80% and 100%, indicating a consistent efficacy signal.
The single-arm trial was the only prospective study (Castellucci, 2021) which included 50 patients and had a mean follow-up of 20 months. The authors stated larger patient population and longer follow-up are needed to confirm the preliminary data and find the optimal dose needed to achieve complete response without significant side effects.
The 5 retrospective case series did not have standardised follow up points and length of follow up varied widely within each sample (range: 288 days to 51 months). No studies reported reasons for loss to follow up.
All 6 studies were done in Italy and had overlaps in the research groups. Four of the 6 studies were conducted in the same hospital and all 6 publications shared at least one author. The dates that people received treatment were not reported in some studies. This may mean that there is some overlap in participants.
Five of the 6 study designs were case series and did not report a clear strategy for patient selection. Cases presented in these reports may have been subject to selection bias. The single-arm trial reported inclusion and exclusion criteria and a clearer protocol for patient identification (Castellucci, 2021).
Five studies included participants whose lesions were on different locations on the body. One study only included participants with lesions on the penis (Carrozzo, 2013). Four studies reported the surface area of the lesion and these appear to be similar. All studies included some participants whose lesions had previously been treated with another intervention before rhenium-188 paste.
Studies used a mixture of histological, dermoscopic and 'clinical assessment' (not otherwise described) methods to determine response status. The single-arm trial was the only study that reported how they classified response status (Castellucci, 2021). They used dermoscopy for all lesions and biopsy was used if needed. This was the only study that used standardised measures to assess cosmetic outcomes and severity of safety events. It was the only study that reported the frequency of safety events. All 5 other studies described the types of adverse events that were observed but did not report the frequency. No studies used patient reported outcome measures.
There was some evolution of the procedure between the earliest (Sedda, 2008) and subsequent publications. The Rhenium-SCT kit was used to apply the radioactive resin in at least 4 studies. Different materials were used to protect the skin (cream only compared to foil or combination) and several versions of the software used to calculate how long to irradiate the lesion were used.
One study pre-planned to fraction the dose across multiple sessions for lesions on the lips and genitals or for thicker lesions (Cipriani, 2017). Two studies delivered the intervention and reported outcomes after 1 session (Cipriani, 2022; Castellucci, 2021). Three studies delivered multiple sessions for some participants (Carrozzo, 2013; Carrozzo, 2014; Sedda, 2008) but 2 did not state when they happened or whether they were pre-planned or triggered by partial or non-response to previous sessions (Carrozzo, 2013; Sedda 2008). Interpretation of treatment success and relapse is difficult in these studies.
Some studies successfully treated large lesions but 5 studies commented that some recurrences related to size, depth of lesion and the success of the security margin mapped around the lesion.
Castellucci (2021) conducted a statistical analysis that showed that grade 3 acute toxicity was significantly related to the surface area treated and the dose.
Multiple authors on the Cipriani (2022) publication were employees, former employees or medical consultants for OncoBeta. OncoBeta were funded to publish the paper. Cipriani (2017) acknowledges support from OncoBeta, MAVIG GmbH and GBN Systems Gmb but do not state this is a conflict of interest.
Ongoing trials:
Efficacy of Personalised Irradiation With Rhenium-Skin Cancer Therapy (SCT) for the Treatment of Non-Melanoma Skin Cancer: A Phase IV, Multi-Centre, International, Open-Label, Single Arm Study(EPIC-Skin; NCT05135052); Australia; n=210; study completion date May 2024.
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