A new nonsurgical treatment for removal of skin cancers is seen as a less-invasive alternative to the traditional method of scraping, freezing and then using a scalpel to dig out basal and squamous cell cancers. Although cautions exist, electronic surface brachytherapy (EBT) utilizes the appealing technology of a small X-ray radiation device held just millimeters from tumors.
The American Academy of Dermatology still labels surgery as the most effective treatment for non-melanoma, the most common type of skin cancers. It says that more studying needs to be done before judgments can be rendered about the effectiveness and safety of EBT.
A miniature X-ray device on wheels can be moved from room to room in a medical facility. X-ray radiation is transmitted directly to the cancer site with help of a mechanical arm and the therapist remains by the patient’s side. This is possible because the therapy does not involve radioactive isotopes or linear accelerators, thus eliminating the need for shielding.
The leading device, the Axxent, is manufactured by Xoft, which has been developing eBx devices since 1998. The company’s website describes the application of “a therapeutic dose of isotope-free radiation directly to a tumor target.” Such precise delivery, it says, keeps down radiation exposure risks to healthy tissues while also minimizing the required number of treatments. It estimates that about one-third of non-melanoma patients – or about one million each year – could potentially use the new treatment. To qualify, tumors must be no greater than five millimeters deep and less than four centimeters across.
The company has not been without its challenges. Days after its acquisition by iCAD, Inc. in 2010, a portable radiation device of its manufacture used for breast cancer treatment was found to have left hundreds of tiny tungsten particles in breast tissue and chest muscles.
Nevertheless, iCAD SEO Ken Ferry expressed optimism for the technology, describing it as a painless alternative “to what can be a very time-consuming and painful procedure.” Approximately 100 of the units have been sold. Dermatologists can administer treatment although some U.S. states require a radiation oncologist for this.
Other concerns were raised in an editorial last month in JAMA Dermatology. “Scant” evidence in the long term exists, the authors wrote, on the efficacy of skin cancer treatment with EBT. The authors acknowledged a contemporary skin cancer epidemic yet cautioned that wide adoption of new radiotherapy technologies should be preceded by “rigorous evidence on efficacy and safety rather than marketing.”
The epidemic that Jama Dermatology references is due to skin cancers being diagnosed each year in the United States at a rate greater than all other cancers combined. More than 3.6 million Americans each year, in fact. Although these are rarely fatal, they can ultimately be disfiguring and their removal are almost always recommended.
