Basal cell carcinoma: 10-year experience with electrochemotherapy

BACKGROUND: Electrochemotherapy (ECT), by combining manageable cytotoxic agents with short electric pulses, represents an effective palliative skin-directed therapy. The accumulated evidence indicates that ECT stands out as a safe and well-tolerated alternative treatment for patients with multiple or large basal cell carcinoma (BCC), who are not suitable for conventional treatments. However, long-term data and shared indications are lacking. METHODS: In this observational study, we retrospectively analyzed 84 prospectively collected patients with multiple, recurrent or locally advanced BCC who were not candidate for standard therapies and received bleomycin-based ECT according to the European Standard Operative Procedures of ECT, from 2006 to 2016. RESULTS: Disease extent was local, locally advanced and metastatic in 40 (48%), 41 (49%) and 3 (3%), respectively. Forty-four (52%) individuals had multiple BCCs. Grade 3 skin toxicity after ECT was observed in 6% of cases. Clearance rate was 50% (95% CI 39-61%). Primary presentation (p = 0.004), tumor size <3 cm (p < 0.001), well-defined borders (p = 0.021), absence of tumor ulceration (p = 0.001), non-aggressive BCC histology (p = 0.046) and age 6469 years were associated with higher complete response rate. In patients with local BCC, the clearance rate was 72.5 and 85% after one or two ECT cycles, respectively. In the laBCC group, 32 patients (78%) achieved an objective response. Five-year recurrence rate for local and laBCC was 20 and 38%, respectively (p 64 0.001). CONCLUSIONS: One or two ECT cycles with bleomycin may be a valuable palliative treatment in well-selected patients with multiple BCCs and favorable tumor features. Validation of predictive factors will be imperative to match patients with optimal ECT treatment modalities. Management of laBCC with ECT warrants further investigation. Trial registration ISRCTN14633165 Registered 24 March 2017 (retrospectively registered)

Digital Onboarding: Facilitators and Barriers to Improve Worker Experience

The pandemic has forced organizations to find new ways of working. In fact, we are seeing an increase in remote working and this has inevitably impacted onboarding processes. In this respect, the aim of this study was to understand how young graduates under 30 experienced digital onboarding (in terms of emotions and cognitions) when joining organizations with structured Human Resources processes. An exploratory qualitative study was conducted in which participants were asked to fill in ethnographic sheets in order to understand the barriers and facilitators that organizations can implement to improve the digital onboarding experience. We used thematic analysis. What emerged from our study is that newcomers struggled, in digital contexts, to find the right information, to be proactive and to receive immediate feedback in order to understandthe context and to understand their fit with the company: it is important not to lose sight of the importance of socialization, but rather to find effective and structured practices that facilitate it and make it last over time. In our study, we argue that a structured digital onboarding program could be a relevant step in order to implement an effective transition towards remote working cultures and an attention to socialization processes

Electrochemotherapy in the treatment of cutaneous metastases from breast cancer: a multicenter cohort analysis.

The management of breast cancer (BC) skin metastases represents a therapeutic challenge. Electrochemotherapy (ECT) combines the administration of bleomycin with temporary permeabilization induced by locally administered electric pulses. Preliminary experience with ECT in BC patients is encouraging. METHODS: A total of 125 patients with BC skin metastases who underwent ECT between 2010 and 2013 were enrolled onto a multicenter retrospective cohort study. The treatment was administered following the European Standard Operative Procedures of Electrochemotherapy. Tumor response was clinically assessed adapting the Response Evaluation Criteria in Solid Tumors, and toxicity was evaluated according to Common Terminology Criteria for Adverse Events 4.0. Cox regression analysis was used to identify predictive factors. RESULTS: Response was evaluable in 113 patients for 214 tumors (median 1 per patient, range 1-3). The overall response rate after 2 months was 90.2 %, while the complete response (CR) rate was 58.4 %. In multivariate analysis, small tumor size (P < 0.001), absence of visceral metastases (P = 0.001), estrogen receptor positivity (P = 0.016), and low Ki-67 index (P = 0.024) were significantly associated with CR. In the first 48 h, 10.4 % of patients reported severe skin pain. Dermatologic toxicity included grade 3 skin ulceration (8.0 %) and grade 2 skin hyperpigmentation (8.8 %). Tumor 1-year local progression-free survival was 86.2 % (95 % confidence interval 79.3-93.8) and 96.4 % (95 % confidence interval 91.6-100) in the subgroup of those with CR. CONCLUSIONS: In this study, small tumor size, absence of visceral metastases, estrogen receptor positivity, and low Ki-67 index were predictors of CR after ECT. Patients who experienced CR had durable local control. ECT represents a valuable skin-directed therapy for selected patients with BC

Treatment of cutaneous metastases of breast cancer with electrochemotherapy: what is the magnitude of clinical benefit?

Not applicable

Bleomycin electrochemotherapy in elderly metastatic breast cancer patients: clinical outcome and management considerations

PURPOSE: To evaluate the efficacy and toxicity of electrochemotherapy (ECT) in elderly metastatic breast cancer (BC) patients. METHODS: Retrospective analysis of 55 patients with superficial metastases who underwent ECT according to the European Standard Operative Procedures of electrochemotherapy. Treatment schedule consisted of intravenous or intratumoral bleomycin followed by locally delivered electric pulses. Statistical comparisons were performed between two groups: the patients aged <70 years (n = 27) and those ≥70 years (n = 28). Treatment outcomes were as follows: complete response (CR) rate, local progression-free survival (LPFS), new lesions-free survival (NLFS), toxicity and patient compliance. RESULTS: Patient groups were comparable for clinical-pathological features, except for the number of comorbidities (P < .001). The median follow-up was 32 months (range 6-53). Overall, CR rate was 40 % and was significantly higher in elderly patients (57 vs. 26 %, P = .023) and in patients with better performance status (PS = 0-1, 53 vs. PS = 2, 21 %, P = .048), although local tumor control showed a trend for lower values (2-year LPFS, 67 vs. 93 % among elderly and young patients, respectively; P = .061). Older women seemed less likely to progress outside the ECT field (2-year NLFS, 39 vs. 30 %, P = .075), but discontinued treatment more frequently due to impaired performance status (P = .002). Local pain was graded ≥3, according to a 10-point visual analog scale, by 16/28 (57.1 %) and 8/28 (28.6 %) elderly patients at 4 and 8 weeks, respectively. Wound debridement was required in 5/28 (18 %) older women, due to G3 skin ulceration. CONCLUSIONS: Elderly BC patients are highly responsive to ECT and achieve durable local tumor control. Physicians should be aware of possible debilitating side effects, such as pain and skin toxicity. Performance status and frailty screening could be a helpful addition to improve patient selection

Care Ethics Management and Redesign Organization in the New Normal

The pandemic period has placed the organizations in a state of great tension. It has generated a situation of confusion, lack of rules, and production-related criticalities that have called into question the very existence of many productive realities. This article aims to highlight the dimensions of care and ethics put in place by HR managers in COVID-19. The objective that animated the authors have focused on the HRM level of medium and large companies in Italy to highlight the protective actions toward people and the organization in the period COVID 19, highlighting what were the ethical values and actions of care put in place. In this article, we wanted to give voice to managers (N = 45, including 21 women and 24 men, aged between 40 and 55 years old) who had management tasks in their organizations by asking them to tell us how they dealt with the challenges imposed by the emergency. In the research, we start from a way of understanding workplaces understood as a “process of ongoing social relationship” within which the HR function is dedicated to the care of the quality of relationships. HR managers have to manage a complex role of mediating between the interests of people and employers by trying to find good mediations

A Qualitative Study on Representations of Intellectual and Relational Capital Among a Group of Managers in an Italian Trade-Union

The way in whichmanagers perceive their organization\u2019s intellectual and social capital has an impact in shaping their choices and how they lead change. The aim of the study was to explore how the managers of a trade union framed the role of its intangible assets in a context of organizational change. A qualitative approach was used; 30 semi-structured interviews were conducted with the leaders of a trade union and then analyzed using the method of thematic analysis. Particular attention was paid to the metaphors the managers used to narrate change. The hypothesis underlying this approach is that metaphors are a meaningful resource in that they can convey how organization and its intangible assets are framed. In the results, three \u201croot metaphors\u201d are illustrated\u2014the trade union seen either as a system of domination, an organism, or a culture\u2014together with the consequences of each of these images for the perception and value attributed to the trade union\u2019s intangible assets. In conclusion, implications for changing management practices and for further research are discussed

Staging, treatment and prognosis: is 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) a possible link of union?

Staging, treatment and prognosis: is 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) a possible link of union