Bleomycin electrosclerotherapy (BEST) for the treatment of vascular malformations. An International Network for Sharing Practices on Electrochemotherapy (InspECT) study group report

Abstract

Background Biomedical applications of electroporation are expanding out of the field of oncology into vaccination, treatment of arrhythmias and now in the treatment of vascular malformations. Bleomycin is a widely used sclerosing agent in the treatment of various vascular malformations. The application of electric pulses in addition to bleomycin enhances the effectiveness of the drug, as demonstrated by electrochemotherapy, which utilizes bleomycin in the treatment of tumors. The same principle is used in bleomycin electrosclerotherapy (BEST). The approach seems to be effective in the treatment of low-flow (venous and lymphatic) and, potentially, even high-flow (arteriovenous) malformations. Although there are only a few published reports to date, the surgical community is interested, and an increasing number of centers are applying BEST in the treatment of vascular malformations. Within the International Network for Sharing Practices on Electrochemotherapy (InspECT) consortium, a dedicated working group has been constituted to develop standard operating procedures for BEST and foster clinical trials. Conclusions By treatment standardization and successful completion of clinical trials demonstrating the effectiveness and safety of the approach, higher quality data and better clinical outcomes may be achieved.

Electrochemotherapy in Aggressive Hemangioma of the Spine: A Case Series and Narrative Literature Review

“…No serious adverse events related to the electric field applied and no bleomycin toxicity were reported for bone and surrounding tissues [ 43 ]. ECT with bleomycin then came out to be a valuable tool in pain reduction and improving the quality of life in patients affected by other bone metastases [ 16 , 44 ] and vascular malformation [ 15 ]. Osteolytic vertebral metastases may present with cortical expansion, soft tissue masses, and vertebral compression fractures, mimicking aggressive VHs [ 22 ].…”

“…Risk factors for bleomycin-induced lung damage include the following: age (over 70 years old), association with other chemotherapy drugs or radiation, dosage (with an incremented risk until 20% in case of more than 450 mg), and cumulative exposure [ 14 ]. Despite the potential threat, bleomycin is already one of the most frequently used sclerotherapy agents and ECT is safely applied in the treatment of vascular tumors [ 15 ]. Campanacci et al [ 16 ] successfully used ECT and bleomycin infusion for the treatment of bone metastases and stressed how ECT-related drawbacks can be reduced with a proper preoperative planning and careful case selection.…”

A proposal for a revision of the phlebographic classification of congenital venous malformations

“…Non-lacunar VM is likely to be more easily completely occluded by sclerotherapy than lacunar VM. On the other hand, non-lacunar VM might be more difficult to treat with new approaches such as electro-sclerotherapy, as the electrode positioning might be more challenging ( 21 - 23 ). However, a dedicated analysis of treatment outcomes in larger, probably multi-centric cohorts is necessary to clarify these possible implications.…”

Acquired Lymphangioma Circumscriptum of the Scrotum: A Case Report

“…LC treatment options include surgical excision, laser ablation, skin fulguration by electrocautery or cryotherapy by liquid nitrogen, and other medical therapies like sirolimus or bleomycin [ 11 , 12 ]. Complete excision is preferred but has a high recurrence rate of up to 27% [ 11 , 12 ]. The rarity and diagnostic challenges of scrotal LC warrant increased clinical vigilance to facilitate accurate diagnosis and management.…”