Electrochemotherapy pre‐treatment in primary squamous vulvar cancer. Our preliminary experience

Perrone, Anna Myriam; Galuppi, Andrea; Borghese, Giulia; Corti, Barbara; Ferioli, Martina; Gatta, Anna Nunzia Della; Bovicelli, Alessandro; Morganti, Alessio Giuseppe; Iaco, Pierandrea De

doi:10.1002/jso.25072

Cited by 20 publications

(17 citation statements)

References 22 publications

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“…Future research has yet to explore the impact of histology, tumor size, number of nodules, and repeated sessions on the electrochemotherapy efficacy. The administration of electrochemotherapy in the neoadjuvant setting could also be evaluated in the context of clinical trials 33. Another implication for future treatment is the combined use of electrochemotherapy and ipilimumab in skin melanoma patients 34 35.…”

Section: Discussionmentioning

confidence: 99%

Use of electrochemotherapy in women with vulvar cancer to improve quality-of-life in the palliative setting: a meta-analysis

Tranoulis

Georgiou

Founta

et al. 2019

Int J Gynecol Cancer

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IntroductionElectrochemotherapy involves the use of transient tumor permeabilization via electric pulses in combination with low-dose chemotherapeutic agents. It has recently emerged as an alternative treatment modality in vulvar cancer. The aim of this meta-analysis was to ascertain the effectiveness of electrochemotherapy in the context of palliative care.MethodsThe following databases were searched: MEDLINE, Scopus, and Cochrane Database, to identify all registered articles pertaining to palliative vulvar cancer treatment with electrochemotherapy from inception until August 2019, in line with PRISMA guidelines. A single-proportion meta-analysis was performed for the outcomes of overall response, complete response, partial response, stable disease, and progressive disease raterespectively, using the random-effect model. Sensitivity analysis was performed to address heterogeneity.ResultsFour studies were included totaling 104 women. The studies were of moderate quality. Pooled results from four studies rendered a summary proportion of 78.8% (95% CI 70.4% to 86.1%) for the outcome of overall response. The median age ranged between 68 and 85 years. The sample size per study ranged between eight and 61 women. The tumors’ histological types included: squamous-cell carcinoma (96.2%), Paget’s disease (2.9%), and malignant melanoma (0.9%). A total of 65 patients (62.5%) presented with a single nodule, whilst 39 patients (37.5%) presented with multiple nodules. Eighty-nine women (85.6%) were previously submitted to other treatment modalities. The overall response rate ranged from 73.2% to 80.9%. The pooled proportion for the outcomes of complete and partial response rate was 48.7% (95% CI 30.74% to 61.5%) and 30.2% (95% CI 21.7% to 39.4%), respectively. The follow-up ranged from 1 to 51 months. No severe adverse effects were reported. The safety profile of electrochemotherapy was favorable.ConclusionsElectrochemotherapy is an effective and minimally invasive treatment modality in the palliative care management of patients with vulvar cancer. The effective control of vulvar tumors by electrochemotherapy may contribute to improvement of quality-of-life. In light of the moderate quality of evidence, a multi-center cooperation is warranted to confirm its palliative benefit.

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Section: Discussionmentioning

confidence: 99%

Use of electrochemotherapy in women with vulvar cancer to improve quality-of-life in the palliative setting: a meta-analysis

Tranoulis

Georgiou

Founta

et al. 2019

Int J Gynecol Cancer

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“…[20][21][22][23][24][25] The neoadjuvant role of ECT has already been considered, though, in single cases and reported in literature as case reports. [26][27][28][29] This work is the first fairly large cohort of patients with cutaneous metastases of different histology treated with ECT with neoadjuvant purposes, 3 months before radical surgery and reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant treatment by ECT in cutaneous malignant neoplastic lesions

Fabrizio

Cagiano

Terlizzi

et al. 2020

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…Treatment of such patients by re-excision or radiation therapy should decrease the incidence of these recurrences and allow closer surgical margins in selected cases. Another possible approach in the future may be the use of electrochemotherapy [33]. However, until a reliable alternative becomes routine, we believe that surgical margins should ideally be 1 cm of macroscopic skin, which translates to a histopathological margin of 8 mm.…”

Section: Discussionmentioning

confidence: 99%

The Prognostic Role of the Surgical Margins in Squamous Vulvar Cancer: A Retrospective Australian Study

Barlow

Jackson

Hacker

2020

Cancers

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For the last 30 years at the Royal Hospital for Women, unifocal vulvar squamous cancers have been treated by radical local excision, aiming to achieve a histopathological margin of ≥8 mm, equating to a surgical margin of 1 cm. The need for a margin of this width has recently been challenged. We aimed to determine the long-term outcome following this conservative approach, and the relationship between vulvar recurrences and surgical margins. Data were obtained retrospectively on 345 patients treated primarily with surgery for squamous vulvar cancer between 1987 and 2017. Median follow-up was 93 months. Five-year disease-specific survival was 86%. Of 78 vulvar recurrences, 33 (42.3%) were at the primary site and 45 (57.7%) at a remote site. In multivariable analysis, a margin < 5 mm showed a higher risk of all vulvar (Hazard ratio (HR), 2.29; CI, 1.12−4.70), and primary site recurrences (subdistribution hazard ratio (SHR), 15.20; CI, 5.21−44.26), while those with a margin of 5 to <8 mm had a higher risk of a primary site recurrence (SHR, 8.92; CI, 3.26−24.43), and a lower risk of remote site recurrence. Excision margins < 8 mm treated by re-excision or radiation therapy had a significantly decreased risk of recurrence. Guidelines should continue to recommend a surgical margin of 1 cm.

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Electrochemotherapy pre‐treatment in primary squamous vulvar cancer. Our preliminary experience

Abstract: Our preliminary analysis suggests that ECT is a suitable treatment in patients with V-SCC before surgery, reducing the tumor size and the surgical resection.

Cited by 20 publications

References 22 publications

Use of electrochemotherapy in women with vulvar cancer to improve quality-of-life in the palliative setting: a meta-analysis

Use of electrochemotherapy in women with vulvar cancer to improve quality-of-life in the palliative setting: a meta-analysis

Neoadjuvant treatment by ECT in cutaneous malignant neoplastic lesions

The Prognostic Role of the Surgical Margins in Squamous Vulvar Cancer: A Retrospective Australian Study

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