Luca G Campana1, Erika Kis2, Krisztina Bottyán2, Antonio Orlando3, Francesca de Terlizzi4, Grammatiki Mitsala3, Rosanna Careri5, Pietro Curatolo5, Marko Snoj6, Gregor Sersa7, Sara Valpione8, Pietro Quaglino9, David Mowatt10, Matteo Brizio9, Hadrian Schepler11. 1. Department of Surgical Oncological and Gastroenterological Sciences - DISCOG, University of Padova, Padova, Italy. Electronic address: luca.campana@unipd.it. 2. Department of Dermatology and Allergology, University of Szeged, Hungary. 3. Department of Plastic and Reconstructive Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, UK. 4. Scientific and Medical Department, IGEA S.p.A., Carpi, Italy. 5. Department of Dermatology and Plastic Surgery, Dermatologic Clinic, University 'La Sapienza', Rome, Italy. 6. Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia. 7. Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia. 8. The Christie NHS Foundation Trust, CRUK Manchester Institute, The University of Manchester, Manchester, UK. 9. Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy. 10. Plastic Surgery Unit, The Christie NHS Foundation Trust, Manchester, UK. 11. Department of Dermatology, University Medical Center, Mainz, Germany.
Abstract
BACKGROUND: Cutaneous angiosarcoma (cAS) is a highly aggressive malignancy that challenges the radicality of surgical treatment. Electrochemotherapy (ECT), a skin-directed treatment based on cytotoxic chemotherapy combined with local electric pulses, may be an intraoperative adjunct and a new opportunity in the therapeutic strategy. This cohort study reports the experience with ECT as an option. METHODS: Data on patients with locally-advanced/metastatic cAS who underwent ECT between October 2013 and October 2018 at eight European centres were prospectively submitted to the InspECT (International network for sharing practices of ECT) register. Patients received therapy according to the European Standard Operating Procedures of ECT (ESOPE). Treatment feasibility was assessed based on tumour coverage with electrodes and recorded tissue current; treatment toxicity and tumour response were graded according to CTCAE v5.0 and RECIST v1.1 criteria, respectively; patient-reported outcomes (PRO) were evaluated using a visual analogue score (VAS) for pain, acceptance of retreatment and the EQ-5D questionnaire. RESULTS: We enrolled 20 patients with advanced cAS in the scalp/face (n = 7), breast/trunk (n = 10) or limbs (n = 3). Target tumours (n = 51) had a median size of 2.3 cm (range, 1-20). We administered 24 ECT courses using 1-4 cm treatment safety margin around tumours. In five patients, ECT was combined/sequenced with surgery. Median tissue current was 3 A (range, 1.5-10), tumour margins coverage rate was 75% (15/20 patients). The objective response rate (ORR) was 80% (complete, 40%). Grade-3 toxicity included skin ulceration (15%) and pain (10%), with no significant change of PRO scores. Bleeding control was achieved in 13/14 patients with ulcerated tumours. With a median overall survival of 12.5 months, the local progression-free survival (LPFS) was 10.9 months. CONCLUSION: ECT produces sustained response rate with minimal side effects and should be considered an option for advanced cAS. Palliative benefits include patient tolerability, local haemostasis and durable local control. Definition of optimal timing, treatment safety margins and combination with surgery need further investigation.
BACKGROUND:Cutaneous angiosarcoma (cAS) is a highly aggressive malignancy that challenges the radicality of surgical treatment. Electrochemotherapy (ECT), a skin-directed treatment based on cytotoxic chemotherapy combined with local electric pulses, may be an intraoperative adjunct and a new opportunity in the therapeutic strategy. This cohort study reports the experience with ECT as an option. METHODS: Data on patients with locally-advanced/metastatic cAS who underwent ECT between October 2013 and October 2018 at eight European centres were prospectively submitted to the InspECT (International network for sharing practices of ECT) register. Patients received therapy according to the European Standard Operating Procedures of ECT (ESOPE). Treatment feasibility was assessed based on tumour coverage with electrodes and recorded tissue current; treatment toxicity and tumour response were graded according to CTCAE v5.0 and RECIST v1.1 criteria, respectively; patient-reported outcomes (PRO) were evaluated using a visual analogue score (VAS) for pain, acceptance of retreatment and the EQ-5D questionnaire. RESULTS: We enrolled 20 patients with advanced cAS in the scalp/face (n = 7), breast/trunk (n = 10) or limbs (n = 3). Target tumours (n = 51) had a median size of 2.3 cm (range, 1-20). We administered 24 ECT courses using 1-4 cm treatment safety margin around tumours. In five patients, ECT was combined/sequenced with surgery. Median tissue current was 3 A (range, 1.5-10), tumour margins coverage rate was 75% (15/20 patients). The objective response rate (ORR) was 80% (complete, 40%). Grade-3 toxicity included skin ulceration (15%) and pain (10%), with no significant change of PRO scores. Bleeding control was achieved in 13/14 patients with ulcerated tumours. With a median overall survival of 12.5 months, the local progression-free survival (LPFS) was 10.9 months. CONCLUSION: ECT produces sustained response rate with minimal side effects and should be considered an option for advanced cAS. Palliative benefits include patient tolerability, local haemostasis and durable local control. Definition of optimal timing, treatment safety margins and combination with surgery need further investigation.
Authors: F Riedel; J Golda; J Held; H L Davies; M W van der Woude; J Bredin; K Niemi; T Gans; V Schulz-von der Gathen; D O'Connell Journal: Plasma Sources Sci Technol Date: 2020-09-17 Impact factor: 3.584
Authors: Alessandra Rossi; Olga N Pakhomova; Peter A Mollica; Maura Casciola; Uma Mangalanathan; Andrei G Pakhomov; Claudia Muratori Journal: Cancers (Basel) Date: 2019-12-17 Impact factor: 6.639