Management of cutaneous metastases using electrochemotherapy

Background. Cutaneous metastases may cause considerable discomfort as a consequence of ulceration, oozing, bleeding and pain. Electrochemotherapy has proven to be highly effective in the treatment of cutaneous metastases. Electrochemotherapy utilises pulses of electricity to increase the permeability of the cell membrane and thereby augment the effect of chemotherapy. For the drug bleomycin, the effect is enhanced several hundred-fold, enabling once-only treatment. The primary endpoint of this study is to evaluate the efficacy of electrochemotherapy as a palliative treatment. Methods. This phase II study is a collaboration between two centres, one in Denmark and the other in the UK. Patients with cutaneous metastases of any histology were included. Bleomycin was administered intratumourally or intravenously followed by application of electric pulses to the tumour site. Results. Fifty-two patients were included. Complete and partial response rate was 68% and 18%, respectively, for cutaneous metastases <3 cm and 8% and 23%, respectively, for cutaneous metastases >3 cm. Treatment was well-tolerated by patients, including the elderly, and no serious adverse events were observed. Conclusions. ECT is an efficient and safe treatment and clinicians should not hesitate to use it even in the elderly

International Network for Sharing Practices on Electrochemotherapy (InspECT): An Integrative Patients Treatment Consortium

In this chapter we will present the International Network for Sharing Practices on Electrochemotherapy group, founded to answer the need of discussing issues and share experience on the use of the procedure, its history, and the objective for what it was established. Furthermore, on 2008 the online InspECT database was created as a tool for the Network to record data regarding clinical general examination of patients, measurement of tumor size to be treated, photographic documentation, type of anaesthesia, data on electrochemotherapy procedure, toxicity, side effects, pain, and quality of life. The amount of information stored is recorded to produce collaborative publications since all the data are entered according to the same parameters and continuously monitored according to good clinical procedures. Thanks to the collaborative work between the members of the Network it was possible to realize the publication of papers focused on specific electrochemotherapy issues. The first of them was about the management of cutaneous metastases from various solid tumors and allowed to state that electrochemotherapy offers a minimally invasive local treatment, provides local disease symptoms control, and improves patient\u2019s quality of life at the cost of only minor side effects. The second work published with the aim to evaluate which patients\u2019 category could be at risk for pain associated with electrochemotherapy identified factors related with an higher risk of postprocedural pain as diagnosis of breast cancer, treatment of preirradiated areas, largest diameter, and repetitive treatments demonstrating, however, that pain levels and pain medication overall decrease after the procedure. Finally, Bertino and Colleagues focused their attention on melanoma and nonmelanoma skin cancers of the head and neck treated with bleomycin electrochemotherapy. Electrochemotherapy resulted an effective treatment option for skin tumors of this specific area and in particular for basal cell carcinoma. The response rate in small, primary, and treatment-naive tumors is high and the functional, anatomical, and aesthetic preservation of the HN structures can be excellent at cost of well-tolerated side effects