IS radiation Used as AN EMPD Treatment?

Radiation therapy (RT), also called radiotherapy, is a cancer treatment that uses doses of radiation to kill cancer cells and shrink tumors. This radiation is strong enough to kill the cancer cells but does not penetrate more than a few centimetres beyond the surface of the skin. RT may be beneficial to some that are medically unfit for surgery, such as elderly individuals, or when surgery is not considered due to the location the extramammary Paget’s disease (EMPD).

Radiation is generally given in a series of treatments, over many days/weeks, to allow healthy cells to recover and to make radiation more effective. Radiation works by disrupting the DNA inside the cells. In the future, advanced technologies such as intensity-modulated RT could improve dose distribution when irradiating areas such as the genitals in EMPD patients.

There are two main types of radiation therapy. They include external beam and internal beam. External beam radiation therapy is a localized treatment that focuses a defined area. External radiation therapies may use varied particles including: photons, protons, and electrons. Since electron beams cannot travel very far through body tissues electron beam therapy is often used with skin cancers. Internal radiation therapy is a treatment in which a source of radiation is placed inside or near the tumor. Internal radiation therapy with a solid source is called brachytherapy (BT). Like external beam radiation therapy, BT is a local treatment and treats only a specific part of the body.

Brachytherapy contrasts with unsealed source radiotherapy, in which a radioisotope is injected into the body to chemically localize to the tissue requiring destruction. In some BT uses – such as Dermo-Beta-Brachytherapy (DBBT) – 192-Ir gamma-emitting isotope is used. Over the past few years the use of beta emitter isotopes 188Re or 166Ho have been introduced to treat extramammary Paget’s disease (EMPD).

DBBT uses individually tailor-made radioactive sources with High-Dose-Rate (HDR) beta radiation. In this technique, a synthetic inert matrix containing a radio-active beta-emitting isotope is applied on the surface of the EMPD. This allows for only the tumour lesion to be irradiated. Physicians in Italy have used this approach with a nanocolloid containing 188Re beta emitting isotope. (The half-life of the evenly distributed isotope is 16.98 hours.) At the end of the irradiation time (typically 30 to 60 minutes) the radioactive mould is removed using a specially designed tong device, and discarded as radioactive waste.

Trying to interpret the success of radiation therapy use with EMPD patients is difficult because radiation fields, doses, and schedules are not standardized with extramammary Paget’s disease (EMPD) patients. RT is often suggested as being less invasive than other treatments such as surgery, with a lower risk of adverse effects, but existing published information has limitations. Medical articles most-often report small-scale retrospective studies that lack long-term observations and thus lack information about the true effects of radiation therapy. RT has been known to impact the ability for skin to heal thus making potential future surgeries more difficult or impossible. Other side-effects can include: lymphedema (swelling, heaviness, or aching), hyperpigmention to the skin, and polyneuropathy (nerve pain, numbness, tingling, burning, hypersensitivity, or weakness).

Treatments for extramammary Paget’s disease (EMPD) often differ but frequently include one or more of the following: Mohs surgery, wide local excision (WLE) surgery, topical creams, carbon dioxide (CO2) laser, photodynamic therapy (PDT), cavitational ultrasonic surgical aspiration (CUSA), radiation therapy, skin grafts, and chemotherapy.

The content presented on this website, encompassing both textual material and visual media, serves educational and informational purposes aimed at aiding individuals affected by extramammary Paget’s disease (EMPD) and their families in comprehending the complexities associated with EMPD. It is imperative to note that the website is not designed to serve as a replacement for professional medical advice, diagnosis, or treatment. Furthermore, the website does not advocate for or endorse any specific treatments, tests, physicians, procedures, or products. Should you suspect that you are experiencing symptoms of EMPD, we strongly advise you to seek guidance from your healthcare provider.