A J P Clover1, F de Terlizzi2, G Bertino3, P Curatolo4, J Odili5, L G Campana6, C Kunte7, T Muir8, M Brizio9, G Sersa10, R Pritchard Jones11, G Moir12, A Orlando13, S M Banerjee14, E Kis15, J A McCaul16, E M Grischke17, P Matteucci18, D Mowatt19, F G Bechara20, M Mascherini21, V Lico22, R Giorgione23, V Seccia24, H Schepler25, G Pecorari26, A D MacKenzie Ross27, B Bisase28, J Gehl29. 1. Department of Plastic Surgery, Cancer Research @UCC, Western Gateway Building, University College Cork, Cork, Ireland. 2. IGEA Biophysics Lab, Carpi, MO, Italy. 3. Department of Otolaryngology Head Neck Surgery, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy. 4. Department of Internal Medicine and Medical Specialties, Division of Dermatology, University of Rome "La Sapienza", Policlinico Umberto I, Rome, Italy. 5. Department of Plastic Surgery, St. Georges University Hospitals NHS Trust, London, United Kingdom. 6. Department of Surgical Oncological and Gastroenterological Sciences DISCOG, University of Padua, Padua, Italy. 7. Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Munich, Germany; Department of Dermatologic Surgery and Dermatology, Artemed Fachklinik Munich, Munich, Germany. 8. James Cook University Hospital, Middlesbrough, United Kingdom. 9. Department of Medical Sciences University of Turin, Dermatologic Clinic, Italy. 10. Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska 2, Ljubljana, Slovenia. 11. Merseyside Plastic Surgery Centre, Liverpool, United Kingdom. 12. Department of Cutaneous Medicine & Surgery, The Royal London Hospital & QMUL, Bart's Health NHS Trust, Skin Cancer SSMDT, London, United Kingdom. 13. Southmead Hospital, North Bristol NHS Trust, Department of Plastic and Reconstructive Surgery, Bristol, United Kingdom. 14. Department of Surgery and Interventional Sciences, Royal Free Campus, University College London, London, United Kingdom. 15. Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary. 16. Maxillofacial Unit, Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom. 17. Universitäts-Frauenklinik, Tuebingen, Germany. 18. Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom. 19. Christie Hospital, Manchester, United Kingdom. 20. Department of Dermatology, Venerology, and Allergology, St Josef Hospital, Ruhr-University Bochum, Germany. 21. Clinica Chirurgica 1 - Ospedale Policlinico San Martino, University of Genova, Italy. 22. Department of General Surgery, Mirano, Italy. 23. Dermatologic Clinic of University of Eastern Piedmont, Novara, Italy. 24. ENT Unit, University Hospital in Pisa, Italy. 25. Department of Dermatology, Johannes Gutenberg University Mainz, Germany. 26. Department of Surgical Sciences, Otolaryngology Clinic, University of Turin, Italy. 27. Department of Plastic Surgery, Guy's and St Thomas' Hospitals, London, United Kingdom. 28. Clinic for Head & Neck Cancer, Queen Victoria Hospital NHS Foundation Trust, West Sussex, United Kingdom. 29. Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark. Electronic address: kgeh@regionsjaelland.dk.
Abstract
BACKGROUND: Electrochemotherapy (ECT) is a treatment for both primary and secondary cutaneous tumours. The international Network for sharing practices on ECT group investigates treatment outcomes after ECT using a common database with defined parameters. METHODS: Twenty-eight centres across Europe prospectively uploaded data over an 11-year period. Response rates were investigated in relation to primary diagnosis, tumour size, choice of electrode type, route of bleomycin administration, electrical parameters recorded and previous irradiation in the treated field. RESULTS: Nine hundred eighty-seven patients, with 2482 tumour lesions were included in analysis. The overall response (OR) rate was 85% (complete response [CR]: 70%, partial response rate: 15%, stable disease: 11%, and progressive disease: 2%). For different histologies, OR and CR rates for metastases of malignant melanoma were 82% and 64%, basal cell carcinoma were 96% and 85%, breast cancer metastases were 77% and 62%, squamous cell carcinoma were 80% and 63% as well as Kaposi's sarcoma were 98% and 91%, respectively. Variance was demonstrated across histotypes (p < 0.0001) and in accordance with size of lesion treated (dichotomised at diameter of 3 cm (p < 0.0001). Hexagonal electrodes were generally used for larger tumours, but for tumours up to 3 cm, linear array electrodes provided better tumour control than hexagonal electrodes (80%:74%, p < 0.003). For tumours more than 2 cm, intravenous administration was superior to intratumoural (IT) administration (p < 0.05). Current recorded varied across tumour histologies and size but did not influence response rate. In previously irradiated areas, responses were selectively lower for IT administration. CONCLUSIONS: These cumulative data endorse efficiency of ECT across a broad range of histotypes. Analysis of 2482 lesions details subgroup analysis on treatment response informing future treatment choices.
BACKGROUND: Electrochemotherapy (ECT) is a treatment for both primary and secondary cutaneous tumours. The international Network for sharing practices on ECT group investigates treatment outcomes after ECT using a common database with defined parameters. METHODS: Twenty-eight centres across Europe prospectively uploaded data over an 11-year period. Response rates were investigated in relation to primary diagnosis, tumour size, choice of electrode type, route of bleomycin administration, electrical parameters recorded and previous irradiation in the treated field. RESULTS: Nine hundred eighty-seven patients, with 2482 tumour lesions were included in analysis. The overall response (OR) rate was 85% (complete response [CR]: 70%, partial response rate: 15%, stable disease: 11%, and progressive disease: 2%). For different histologies, OR and CR rates for metastases of malignant melanoma were 82% and 64%, basal cell carcinoma were 96% and 85%, breast cancer metastases were 77% and 62%, squamous cell carcinoma were 80% and 63% as well as Kaposi's sarcoma were 98% and 91%, respectively. Variance was demonstrated across histotypes (p < 0.0001) and in accordance with size of lesion treated (dichotomised at diameter of 3 cm (p < 0.0001). Hexagonal electrodes were generally used for larger tumours, but for tumours up to 3 cm, linear array electrodes provided better tumour control than hexagonal electrodes (80%:74%, p < 0.003). For tumours more than 2 cm, intravenous administration was superior to intratumoural (IT) administration (p < 0.05). Current recorded varied across tumour histologies and size but did not influence response rate. In previously irradiated areas, responses were selectively lower for IT administration. CONCLUSIONS: These cumulative data endorse efficiency of ECT across a broad range of histotypes. Analysis of 2482 lesions details subgroup analysis on treatment response informing future treatment choices.
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