Gregor Sersa1, Matteo Mascherini2, Claudia Di Prata3, Joy Odili4, Francesca de Terlizzi5, Gordon A G McKenzie6, A James P Clover7, Giulia Bertino8, Romina Spina9, Ales Groselj10, Rocco Cappellesso11, Julie Gehl12, Brian Bisase13, Pietro Curatolo14, Erika Kis15, Valbona Lico16, Tobian Muir17, Antonio Orlando18, Pietro Quaglino19, Paolo Matteucci20, Sara Valpione21, Luca G Campana22. 1. Institute of Oncology Ljubljana, Department of Experimental Oncology, Zaloska 2, SI-1000, Ljubljana, Slovenia; University of Ljubljana, Faculty of Health Sciences, Zdravstvena Pot 5, SI-1000, Ljubljana, Slovenia. Electronic address: gsersa@onko-i.si. 2. Clinica Chirurgica-1, Ospedale Policlinico San Martino, University of Genova, Italy. Electronic address: mascherinimatteo@gmail.com. 3. University of Padua School of Surgery, Padua, Italy. Electronic address: claudia.diprata.md@gmail.com. 4. Department of Plastic Surgery, St George's Hospital, London, United Kingdom. Electronic address: joy.odili@virginmedia.com. 5. Scientific & Medical Department, IGEA S.p.A, Via Parmenide 10/A, 41012, Carpi, Mo, Italy. Electronic address: f.deterlizzi@igeamedical.com. 6. Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull HU6 7RX, United Kingdom. Electronic address: Gordon.McKenzie@hey.nhs.uk. 7. Department of Plastic Surgery, Cork University Hospital and Cancer Research@UCC, University College Cork, Cork, Ireland. Electronic address: j.clover@ucc.ie. 8. Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, 27100, Pavia, Italy. Electronic address: giulia.bertino68@gmail.com. 9. Veneto Institute of Oncology IOV-IRCCS, Padua, Italy. Electronic address: romina.spina@iov.veneto.it. 10. Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloska 2, SI-1000, Ljubljana, Slovenia; University of Ljubljana, Faculty of Medicine, Vrazov trg 2, SI-1000, Ljubljana, Slovenia. Electronic address: ales.groselj@kclj.si. 11. Pathological Anatomy Unit, Padua University Hospital, Padua, 35121, Italy. Electronic address: rocco.cappellesso@gmail.com. 12. Center for Experimental Drug and Gene Electrotransfer (C∗EDGE), Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Køge, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Electronic address: kgeh@regionsjaelland.dk. 13. Clinic for Head & Neck Cancer, Queen Victoria Hospital NHS Foundation Trust, West Sussex, United Kingdom. Electronic address: brian.bisase@nhs.net. 14. Department of Internal Medicine and Medical Specialties - Division of Dermatology, University "La Sapienza", Rome, Italy. Electronic address: pietro.curatolo@uniroma1.it. 15. Department of Dermatology and Allergology, University of Szeged, Hungary. Electronic address: ksgbrll@gmail.com. 16. Chirurgia Generale ULSS 3, erenissima, Mirano, Italy. Electronic address: valbona.lico@aulss3.veneto.it. 17. James Cook University Hospital, Middlesbrough, United Kingdom. Electronic address: tobian.muir@nhs.net. 18. Department of Plastic and Reconstructive Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom. Electronic address: antonio.orlando@nbt.nhs.uk. 19. Dermatologic Clinic, Department of Medical Sciences, University of Turin Medical School, Turin, Italy. Electronic address: pietro.quaglino@unito.it. 20. Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom. Electronic address: paolo.matteucci@hey.nhs.uk. 21. Cancer Research UK, The University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom. Electronic address: sara.valpione@cruk.manchester.ac.uk. 22. Department of Surgical Oncological and Gastroenterological Sciences (DISCOG), University of Padua, Padua, Italy; The Christie NHS Foundation Trust, Manchester, United Kingdom. Electronic address: luca.campana@nhs.net.
Abstract
BACKGROUND: With extending life expectancy, more people are diagnosed with cutaneous malignancies at advanced ages and are offered nonsurgical treatment. We assessed outcomes of the oldest-old adults after electrochemotherapy (ECT). METHODS: The International Network for Sharing Practices of ECT (InspECT) registry was queried for adults aged ≥90 years (ys) with skin cancers/cutaneous metastases of any histotype who underwent bleomycin-ECT (2006-2019). These were subanalysed with patients aged <90 ys after matching 1:2 for tumor location, number, size, histotype, and previous treatments. We assessed ECT modalities, toxicity (CTCAE), response (RECIST), and patient perception (EQ-5D). RESULTS: Sixty-one patients represented the study cohort (median 92 ys, range 92-104), 122 the control group (median 77 ys, range 23-89). Among the oldest-old, 44 patients (72%) had primary/recurrent skin cancers, 17 (28%) cutaneous metastases. Median tumour size was 15 mm (range, 5-450). The oldest-old adults underwent ECT mainly under local/regional anaesthesia (59% vs 39% p = .012). We observed no differences regarding dose and route of chemotherapy (intravenous vs intratumoral, p = .308), electrode geometry (linear vs hexagonal, p = .172) and procedural duration (18 vs 21 min, p = .378). Complete response (57.4 [95%-CI 44.1%-70.0%] vs 64.7% [95%-CI 55.6%-73.2%], p = .222) and 1-year local control (76.7% vs 81.7, p = .092) rates were comparable. Pain and skin hyperpigmentation were mild in both groups. Skin ulceration persisted longer in the oldest-old patients (4.4 vs 2.4 months, p = .008). CONCLUSIONS: The oldest-old adults with cutaneous malignancies undergo ECT most commonly under local/regional anaesthesia with safety profiles and clinical effectiveness similar to their younger counterparts, except in case of ulcerated tumors.
BACKGROUND: With extending life expectancy, more people are diagnosed with cutaneous malignancies at advanced ages and are offered nonsurgical treatment. We assessed outcomes of the oldest-old adults after electrochemotherapy (ECT). METHODS: The International Network for Sharing Practices of ECT (InspECT) registry was queried for adults aged ≥90 years (ys) with skin cancers/cutaneous metastases of any histotype who underwent bleomycin-ECT (2006-2019). These were subanalysed with patients aged <90 ys after matching 1:2 for tumor location, number, size, histotype, and previous treatments. We assessed ECT modalities, toxicity (CTCAE), response (RECIST), and patient perception (EQ-5D). RESULTS: Sixty-one patients represented the study cohort (median 92 ys, range 92-104), 122 the control group (median 77 ys, range 23-89). Among the oldest-old, 44 patients (72%) had primary/recurrent skin cancers, 17 (28%) cutaneous metastases. Median tumour size was 15 mm (range, 5-450). The oldest-old adults underwent ECT mainly under local/regional anaesthesia (59% vs 39% p = .012). We observed no differences regarding dose and route of chemotherapy (intravenous vs intratumoral, p = .308), electrode geometry (linear vs hexagonal, p = .172) and procedural duration (18 vs 21 min, p = .378). Complete response (57.4 [95%-CI 44.1%-70.0%] vs 64.7% [95%-CI 55.6%-73.2%], p = .222) and 1-year local control (76.7% vs 81.7, p = .092) rates were comparable. Pain and skin hyperpigmentation were mild in both groups. Skin ulceration persisted longer in the oldest-old patients (4.4 vs 2.4 months, p = .008). CONCLUSIONS: The oldest-old adults with cutaneous malignancies undergo ECT most commonly under local/regional anaesthesia with safety profiles and clinical effectiveness similar to their younger counterparts, except in case of ulcerated tumors.