Elizabeth Paton, Gerald Fogarty, Stephen Shumack, Vicki Howard
Aims: Rosacea is a common chronic illness with an unknown cause and no known durable cure. Recalcitrant rosacea (RR) is rosacea that has recurred following treatment. A published case series showed 4 cases of inadvertent incidental control of in-field RR at an average of 21 months following definitive modern radiotherapy for multifocal basal cell carcinoma (BCC) of the nose. Volumetric modulated arc therapy (VMAT) was used, and control was associated with target volumes receiving at least 36.5 Grey in an average of 22.5 fractions.
Methods: We have proceeded to a randomised controlled trial (RCT) comparing modern radiotherapy to standard of care (SOC). A literature review was done, a protocol developed and ethics approval sought, with accrual planned at three NSW sites.
Results: Inclusion criteria include those over 60 years with RR, rosacea score of 3–4 as defined by the Investigator Global Assessment (IGA) scale for rosacea; exclusion criteria include telangiectasia sub-type and involvement of the forehead. SOC includes as single or in combination topical therapies such as Metronidazole. Ivermectin (1%), laser or light therapy; vascular laser or Intense pulse light treatment; and systemic therapy such as doxycycline and minocycline.
An exploratory translational study will attempt to characterise the effect of VMAT at a histopathological level and evaluate the concordance between clinical and histopathological disease assessments, which will require pre and post biopsies.
The primary objective Is the efficacy of VMAT compared to the SOC at 12 months, with a secondary at 24 months. This will be based on the avoidance of in-field failure, which is defined as an increase to an IGA score of 2 or higher following initial clearance to 0 or 1. Cross over is allowed.
Conclusions: VMAT for RR requires an RCT. Dr Fogarty is attending the ACD ASM and is reachable in 0401881883, or on email@example.com