Electrochemotherapy in Mucosal Cancer of the Head and Neck: A Systematic Review

Abstract

Electrochemotherapy (ECT) is a local ablative treatment that is based on the reversible electroporation and intracellular accumulation of hydrophilic drug molecules, which greatly increases their cytotoxicity. In mucosal head and neck cancer (HNC), experience with ECT is limited due to the poor accessibility of tumors. In order to review the experience with ECT in mucosal HNC, we undertook a systematic review of the literature. In 22 articles, published between 1998 and 2020, 16 studies with 164 patients were described. Curative and palliative intent treatment were given to 36 (22%) and 128 patients (78%), respectively. The majority of tumors were squamous cell carcinomas (79.3%) and located in the oral cavity (62.8%). In the curative intent group, complete response after one ECT treatment was achieved in 80.5% of the patients, and in the palliative intent group, the objective (complete and partial) response rate was 73.1% (31.2% and 41.9%). No serious adverse events were reported during or soon after ECT and late effects were rare (19 events in 17 patients). The quality-of-life assessments did not show a significant deterioration at 12 months post-ECT. Provided these preliminary data are confirmed in randomized controlled trials, ECT may be an interesting treatment option in selected patients with HNC not amenable to standard local treatment.

Quality of Life in Electrochemotherapy for Cutaneous and Mucosal Head and Neck Tumors

“…A recent review about ECT in mucosal head and neck cancer showed that it was used with a palliative intent in 78% of cases with an overall objective response rate of 73% [ 3 ]. Longo et al observed an objective response in 45% of subjects (5% CR, 40% PR) with advanced skin and mucosal head and neck tumors [ 17 ].…”

“…Electrochemotherapy (ECT) emerged as a local ablative procedure using electroporation for enhanced drug (bleomycin or cisplatin) delivery to tumor cells by generating transient permeation structures in the cell membrane [ 2 ]. In the last three decades, ECT showed its effectiveness in the treatment of cutaneous, subcutaneous, mucosal, or deep seated cancer with different histologies [ 3 , 4 , 5 , 6 ]. The European Standard Operating procedure of Electrochemotherapy (ESOPE) was published in 2006 and updated in 2018 [ 2 ].…”

“…The European Standard Operating procedure of Electrochemotherapy (ESOPE) was published in 2006 and updated in 2018 [ 2 ]. ECT has been used with curative or palliative intent for head and neck cancer [ 3 ]. It is effective in pain and bleeding control of tumor masses.…”

Electrochemotherapy: An Alternative Strategy for Improving Therapy in Drug-Resistant SOLID Tumors

“…Pre-clinical studies performed on radio-resistant human pharyngeal cancer cells have confirmed the enhanced cytotoxic effect of the combination of bleomycin with electrical pulses [ 83 ]. Several clinical studies are ongoing using ECT either as cytoreductive treatment (preoperative phase) to reduce tumor mass prior to therapy, or as primary treatment for early-stage tumors [ 84 ].…”

Palliative repeated electroporations of oral tumours in dogs: A case series

“…Other local ablative treatment options have been investigated, and electrochemotherapy (ECT) seems to have encouraging results ( 7 – 10 ). The use of ECT has been widely studied in human medicine, especially for local control of oral cavity tumours and for neoplasms of the head and neck region ( 11 – 13 ). Recently, ECT has also been investigated as a treatment for oral cavity tumours in dogs, in particular for MM and SCC ( 8 , 9 ).…”