Cold Atmospheric Pressure Plasma (CAP) as a New Tool for the Management of Vulva Cancer and Vulvar Premalignant Lesions in Gynaecological Oncology

Abstract

Vulvar cancer (VC) is a specific form of malignancy accounting for 5–6% of all gynaecologic malignancies. Although VC occurs most commonly in women after 60 years of age, disease incidence has risen progressively in premenopausal women in recent decades. VC demonstrates particular features requiring well-adapted therapeutic approaches to avoid potential treatment-related complications. Significant improvements in disease-free survival and overall survival rates for patients diagnosed with post-stage I disease have been achieved by implementing a combination therapy consisting of radical surgical resection, systemic chemotherapy and/or radiotherapy. Achieving local control remains challenging. However, mostly due to specific anatomical conditions, the need for comprehensive surgical reconstruction and frequent post-operative healing complications. Novel therapeutic tools better adapted to VC particularities are essential for improving individual outcomes. To this end, cold atmospheric plasma (CAP) treatment is a promising option for VC, and is particularly appropriate for the local treatment of dysplastic lesions, early intraepithelial cancer, and invasive tumours. In addition, CAP also helps reduce inflammatory complications and improve wound healing. The application of CAP may realise either directly or indirectly utilising nanoparticle technologies. CAP has demonstrated remarkable treatment benefits for several malignant conditions, and has created new medical fields, such as “plasma medicine” and “plasma oncology”. This article highlights the benefits of CAP for the treatment of VC, VC pre-stages, and postsurgical wound complications. There has not yet been a published report of CAP on vulvar cancer cells, and so this review summarises the progress made in gynaecological oncology and in other cancers, and promotes an important, understudied area for future research. The paradigm shift from reactive to predictive, preventive and personalised medical approaches in overall VC management is also considered.

Glutamine Deprivation Synergizes the Anticancer Effects of Cold Atmospheric Plasma on Esophageal Cancer Cells

“…This is because of the improved metabolism (to support the fast growth) of cancer cells, which needs considerable glutamine/glutathione than normal cells. As shown, glutamine is highly active in many human cancers, including triple-negative breast cancer, vulvar cancer, lymphoma, pancreatic cancer and lung cancer [ 55 , 56 ]. These demonstrate the rationale of glutamine-targeted treatment.…”

Open Questions in Cold Atmospheric Plasma Treatment in Head and Neck Cancer: A Systematic Review

“…Nevertheless, it is generally accepted that RONS are the major agents responsible for CAP-promoted biological outcomes [ 97 ]. Indeed, it has been shown that the physical effects seem to have a minor biological impact, while RONS may induce intracellular ROS increase, antioxidant enzymes decrease, DNA double-strand brakes, and consequently, apoptosis, according to cell type and exposure parameters [ 98 ]. Ramireddy et al [ 79 ] showed that H 2 O 2 generation increased immediately after He plasma treatment accounting for the anti-cancer effects observed in OSCC cell lines.…”

Intracellular Responses Triggered by Cold Atmospheric Plasma and Plasma-Activated Media in Cancer Cells

“…Hydrogen peroxide H 2 O 2 , the recombination product of • OH and OCl − is the most likely formed reactive oxygen species [ 35 ] and is speculated to be the one toxic trigger, particularly of cancer cells response [ 36 ]. Recently, intracellular signalling cascades have been reviewed and schematically presented elsewhere [ 9 , 37 ], yet here we shall focus on them, regarding their sequential activation in different subcellular compartments.…”