P22 Electrochemotherapy: two years of experience in a cancer center

Abstract

Introduction We started to perform Electrochemotherapy (ECT) in Lisbon since February 2008. We initially treated mainly Melanoma patients but with the growing knowledge on this technique we treat now different kind of presentations in pathologies of the skin, of the mucosa and even intraabdominal progression of oncological diseases. In our point of view the surgical management of cutaneous and subcutaneous tumours, especially metastatic lesions, can be difficult for the surgeon. The treatment may be complex regarding the type, the location or even the number of these lesions. In this cases ECT is a good option and is now a standard procedure in our Institute, giving us the chance to treat less aggressively the patient when we talk about advanced skin cancer or skin involvement by other types of tumours [1-3]. Materials and methodsSince 19 February of 2008 we selected 113 patients to the procedure. We perform ECT under the ESOPE protocol. The patients were treated by Electrochemotherapy using either bleomycin or cisplatin in low doses followed by application of electric pulses to the tumours by the CE labelled electric pulse generator CliniporatorTM (IGEA S.r.l., Carpi, Italy), in order to potentiate cytotoxicity of theChemotherapeutics using plate or needle electrodes. We used the N-50-5I finger prototype for mucosal approach. ResultsWe have already performed 129 sessions of ECT since that. We have made 4394 electroporations with a maximum of 124 applications in a single sessions and a maximum of 7 sessions in the same patient. The ECT treatments were mainly for lower limbs and trunk disease (84% of all treatments). We perform mainly palliative management (84%). The mucosal patients that we treat (a primary melanoma of the anal canal and a recurrence of a vulvar melanoma) allow us to avoid amputation surgeries. One of the patients that we treat perform intraabdominal ECT (3 sessions). He had now a follow up of 12 month with an acceptable control of the disease. The complete response rate was 88% in our series with an overall response rate of 97%. During the follow up we only confirm the histological response in the mucosal lesions. The response of the intraabdominal patient treated was evaluated by PET-scan at week 4 and 10. We had 13.5% of complications (pain-4% and scar-10%) that we think are related with some over treated lesions. RESULTSECT is a simple and effective technique and allows us to reduce the necessity of multiple surgeries in this group of patients. The complication rate is low. The application of the technique in other areas than the skin is possible and could be an option in the future in combination with other surgical and medical approaches. References 1 Mir LM, Glass LF, Sersa G, Teissié J, Domenge C, Miklavcic D, et al. Effective treatment of cutaneous and subcutaneous malignant tumours byelectrochemotherapy.

Electrochemotherapy for primary skin cancer and skin metastasis related to other malignancies

“…Preclinical developments before the use of electrochemotherapy first in human patients, and subsequent research, helped define its mechanism of action, the most effective treatment parameters, both electrical and pharmacological, and the most suitable operating procedures for safe and reproducible treatments. Electrochemotherapy has been repeatedly and independently shown to be highly effective in providing local tumor control and palliation of symptomatic lesions located in cutaneous or subcutaneous tissues regardless of their histological origin, while maintaining a very low toxicity profile and high patient acceptance [40][41][42][43][44][45][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65].…”

“…Electrochemotherapy has also been used as a limb-sparing treatment, effectively avoiding amputation, in a patient presenting with bleeding melanoma metastasis [52] and as a cytoreductive treatment before surgical resection and/or adjuvant therapy [53]. Treatment of a primary melanoma of the anal canal and a recurrence of a vulvar melanoma in separate patients, at the same institution allowed local disease control without amputation surgery [54]. In a palliative setting, the advantages of electrochemotherapy are one-time treatment, the low level of side effects, and the option to repeat the treatment to effectively control disease progression to the skin [55].…”