Electrochemotherapy as an Alternative Treatment Option to Pelvic Exenteration for Recurrent Vulvar Cancer of the Perineum Region

Abstract

Objective: Pelvic exenteration in women with recurrent vulvar carcinoma is associated with high morbidity and mortality and substantial treatment costs. Because pelvic exenteration severely affects the quality of life and can lead to significant complications, other treatment modalities, such as electrochemotherapy, have been proposed. The aim of this study was to evaluate the feasibility and suitability of electrochemotherapy in the treatment of recurrent vulvar cancer. We aimed to analyze the treatment options, treatment outcomes, and complications in patients with recurrent vulvar cancer of the perineum. Methods: A retrospective analysis of patients who had undergone pelvic exenteration for vulvar cancer at the Institute of Oncology Ljubljana over a 16-year period was performed. As an experimental, less mutilating treatment, electrochemotherapy was performed on one patient with recurrent vulvar cancer involving the perineum. Comparative data analysis was performed between the group with pelvic exenteration and the patient with electrochemotherapy, comparing hospital stay, disease recurrence after treatment, survival after treatment in months, and quality of life after treatment. Results: We observed recurrence of disease in 2 patients with initial FIGO stage IIIC disease 3 months and 32 months after pelvic exenteration, and they died of the disease 15 and 38 months after pelvic exenteration. Two patients with FIGO stage IB were alive at 74 and 88 months after pelvic exenteration. One patient with initial FIGO stage IIIC was alive 12 months after treatment with electrochemotherapy with no visible signs of disease progression in the vulvar region, and the lesions had a complete response. The patient treated with electrochemotherapy was hospitalized for 4 days compared with the patients with pelvic exenteration, in whom the average hospital stay was 19.75 (± 1.68) days. Conclusion: Our experience has shown that electrochemotherapy might be a less radical alternative to pelvic exenteration, especially for patients with initially higher FIGO stages.

Intraoperative implantation of 125I seeds improves prognosis in refractory stage IIIB cervical cancer: a case report and literature review

“…Vivod G et al showed that electrochemotherapy might be a less radical alternative to pelvic exenteration, which is feasible and suitable for the treatment of recurrent vulvar cancer. Electrochemical therapy may be used for the treatment of locally recurrent cervical cancer [ 15 ].…”

Safety and Feasibility of Vulvar Cancer Treatment with Electrochemotherapy

“…Little is known about the safety and feasibility of electrochemotherapy treatment in gynecologic cancers. In the literature at present, there are only a few articles or clinical cases describing the use of electrochemotherapy in patients with vulvar or vaginal cancers for palliative purposes [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. In these articles, detailed feasibility data are lacking.…”

“…In addition to being safe and effective as a form of monotherapy, electrochemotherapy can be successfully combined with other standard treatments, such as targeted therapies (vemurafenib and dabrafenib) [ 13 ] or immunotherapy (pembrolizumab) [ 14 ]. To date, only a few articles or clinical cases have been published describing the use of electrochemotherapy in patients with vulvar cancer for palliative purposes [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. In these articles, the safety and local efficacy of electrochemotherapy have been demonstrated; however, a detailed analysis of the safety and feasibility of electrochemotherapy in vulvar cancer patients is lacking.…”

Treatment of vulvar cancer recurrences with electrochemotherapy – a detailed analysis of possible causes for unsuccessful treatment

“…13,14 Safety and local efficacy after electrochemotherapy with bleomycin in locoregional cutaneous recurrences of vulvar carcinomas previously treated with chemotherapy, radiotherapy and surgery or unsuitable for standard treatments have been demonstrated. [15][16][17][18][19] The effectiveness of the clinical cases and studies is presented in Table 1. The success rate of such tumors is 80%, which is lower than the response rate of other skin tumors treated with electrochemotherapy.…”