Stop the Brachytherapy Madness

Someone please stop the skin cancer radiation therapy madness! In exactly 12 months I have seen five cases of severe soft tissue radiation injury to the anterior shin from local radiation for skin cancer. I have been able to really help 3 of these patients, using every trick I’ve got. Honestly, those are not the best statistics.

And what is really worrying me is that if my practice has had 5 of them in 12 months, HOW MANY MORE ARE OUT THERE? WHAT THE HECK IS GOING ON? WHEN DID THIS START? CAN ANYONE STOP THIS?

Case 1: 72-year-old White female, healed 2 months after brachytherapy to the left shin for squamous cell cancer (SCCS).Brachytherapy case 1

Case 2: 78-year-old White female smoker who underwent brachytherapy radiation to the left shin for a squamous cell cancer, and then required MOHs surgery within the irradiated field. Her non- healing wound had been present for 4 months when she started seeing me. She has a normal skin perfusion pressure to the leg, so her arterial flow is fine. I got with closed after 9 months of advanced wound care.Brachytherapy case 2

Case 3: 86-year-old White female with COPD on oxygen and CHF who underwent brachytherapy to the right shin for squamous cell cancer and had had a non-healing wound for 10 months before she came to see me, with hospitalizations for severe cellulitis requiring IV antibiotics. Her skin perfusion pressure is normal (60 mmHg) although her PVR is monophasic (meaning, her main problem is probably not that she doesn’t have arterial flow). She’s now had 3 months of wound care, and I think I might get this one closed in 2 or 3 more months.Brachytherapy case 3

Case 4: 69-year-old White male diabetic, 7.5 months after undergoing brachytherapy to the right shin for a basal cell cancer. Arterial perfusion to the leg is normal by skin perfusion pressure, but he has a low transcutaneous oxygen values in the irradiated failed. I made almost no progress with this wound despite hyperbaric oxygen therapy, negative pressure wound therapy, cellular products and advanced wound dressings.Brachtherapy case 4

Case 5: 66 y.o. White female who underwent brachytherapy to the left shin for a basal cell cancer about 2 months prior. She has diabetes but her arterial supply was normal. The pain on her anterior shin was excruciating and incapacitating. After just a few visits it seemed clear that the best option for her would be a wide excision and a plastic surgical flap, but she had healthcare crisis with a family member and I am not sure what happened to her. This is the worst one I have seen and it was also the first patient I saw of this epidemic of shin brachytherapy for skin cancer, in the spring of 2016, in Houston, Texas. Will no one stop this madness?

brachytherapy case 5a

brachytherapy case 5b