Epidermal radiotherapy using rhenium-188 paste for non-melanoma skin cancer

NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 7 sources, which was discussed by the committee. The evidence included approximately 240 people from an interim analysis of 1 prospective single-arm trial, 1 prospective single-arm trial, 1 prospective single-arm pilot study and 5 retrospective case series. It is presented in the summary of key evidence section in the interventional procedures overview.

The professional experts and the committee considered the key efficacy outcomes to be: remission status and cosmesis (including the use of validated patient-reported outcome measures), recurrence rate and long-term outcomes.

The professional experts and the committee considered the key safety outcomes to be: pain, oedema, redness and scarring.

Patient commentary was sought but none was received.

The procedure should only be done in a unit with Radioactive Substance Advisory Committee approval for the use of radioisotopes, in line with the licence for treatment.

The procedure can be repeated and multiple lesions can be treated at the same time.

The committee was informed that the procedure may result in better cosmetic outcomes than surgery and some other treatments.

The procedure cannot be used safely on the upper eyelid because of potential damage to the cornea.

The committee was informed that there are uncertainties around the dose and safety margins used in this procedure and the long-term risk of secondary malignancy.

The committee was informed that there is an ongoing study that includes a larger sample of people with non-melanoma skin cancer than in the published studies.