The evolving landscape in the management of gastric metastases from melanoma: a case series

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Chirurgia ed Elettrochemioterapia (ECT): nuova possibilità nel trattamento delle localizzazioni ai tessuti molli di tumori a diversa istologia

Aim: Elettrochemotherapy (ECT) is a new technique for treatment of superficial solid tumours of different histologies that don’t respond to conventional therapies. It combines chemotherapy and electric pulses by appropriate device (Clinoporetor, IGEA-Srl, Italy) that permeabilize, with appropriate parameters, the cell membrane in a transient and reversible manner, allowing low penetrating drugs to enter the cell, to get to high concentrations and thus magnifying their cytotoxicity. Moreover, the association of ECT with surgical debulking also permits the treatment of cancer lesions very deep and large. Methods: From March 2007 to March 2009 we treated fifteen patients with cancer metastases with different histology: melanoma, leiomiosarcoma, gastric cancer, breast cancer, squamocellular cancer of scalp. All patients previously undergone surgical debulking. Intravenous infusion of Bleomycin (15 mg/m2) ECT was administered before ECT, than electric pulses were applied on the debalked areas using needle electrodes in a time window of 20-30 minutes. All procedures were performed in general anaesthesia. All patients were also treated with systemic therapies. Results: The treatment was safe and well tolerated. Starting from the second/third week from the treatment, all pts showed a slow progressive necrotic and fibro-sclerotic evolution of the areas treated (verified also with TAC or RMN radiograms and biopsies aimed). Twelve patients with local R0 or R1 disease never showed relaps in the treated area. Tree patients of this group died after 2 and 3 month because of a rapid spreading of the tumor in other regions of the body. In the second group of 3 patients with residual deseas after surgical debulking, two patient showed a slow relapse of tumor, and one patient a progressive regression with a “restitutio ad integrum” for second intention. Moreover 2 of these patients showed the appearance of new lesions on the areas located near the region treated with ECT and surgery debulking. The median overall survival of the entire group was 4+ month (1+ - 15+), and the cause of death was been in all patients a sistemic evolution of the tumor. Conclusions: Our data confirm that ECT is a promising and safe treatment for superficial lesions from different malignancies. General anaesthesia and surgical debulking permit to treat very large and deeper lesion with a good local control. Surgical debulking, concomitant systemic treatment and no rapid disease spreading were related to a better local control and survival

Long-term results of thoracoscopic ablation of paroxysmal atrial fibrillation: is the glass half full or half empty?

Previous series showed the outcomes of thoracoscopic ablation of stand-alone symptomatic paroxysmal atrial fibrillation (AF) for up to 7 years of follow-up. The goal of this study was to assess the long-term durability of surgical pulmonary vein isolation (PVI) beyond 7 years