Treatment of Basal Cell Carcinoma with Electrochemotherapy: Insights from the InspECT Registry (2008–2019)

Abstract

This prospective registry-based study aims to describe electrochemotherapy (ECT) modalities in basal cell carcinoma (BCC) patients and evaluate its efficacy, safety, and predictive factors. The International Network for Sharing Practices of Electrochemotherapy (InspECT) multicentre database was queried for BCC cases treated with bleomycin-ECT between 2008 and 2019 (n = 330 patients from seven countries, with 623 BCCs [median number: 1/patient; range: 1–7; size: 13 mm, range: 5–350; 85% were primary, and 80% located in the head and neck]). The procedure was carried out under local anaesthesia in 68% of cases, with the adjunct of mild sedation in the remaining 32%. Of 300 evaluable patients, 242 (81%) achieved a complete response (CR) after a single ECT course. Treatment naïvety (odds ratio [OR] 0.35, 95% confidence interval [C.I.] 0.19–0.67, p = 0.001) and coverage of deep tumour margin with electric pulses (O.R. 5.55, 95% C.I. 1.37–21.69, p = 0.016) predicted CR, whereas previous radiation was inversely correlated (O.R. 0.25, p = 0.0051). Toxicity included skin ulceration (overall, 16%; G3, 1%) and hyperpigmentation (overall, 8.1%; G3, 2.5%). At a 17-month follow-up, 28 (9.3%) patients experienced local recurrence/progression. Despite no convincing evidence that ECT confers improved outcomes compared with standard surgical excision, it can still be considered an opportunity to avoid major resection in patients unsuitable for more demanding treatment. Treatment naïvety and coverage of the deep margin predict tumour clearance and may inform current patient selection and management.

High-Frequency Electroporation and Chemotherapy for the Treatment of Cutaneous Malignancies: Evaluation of Early Clinical Response

“…Specifically, the outcome data for melanoma (CR 85.6%) are at least comparable to data published by Kunte et al who demonstrated an OR of 78% and a CR of 58% [12]. Similarly, CR in the BCC cohort (83.3%) was equivocal to previous studies which showed response rates of 72.5% [15], 81% after a single treatment [26], further demonstrating the efficacy of HF-EP across different histiotypes.…”

Pulsed Electric Fields in Oncology: A Snapshot of Current Clinical Practices and Research Directions from the 4th World Congress of Electroporation

“…Still, it is impossible to make general considerations because there are only sporadic studies, mainly focusing on single approaches [ 256 , 257 , 258 , 259 ], and a lack of comparative analyses. Finally, the best available evidence for PEF-based therapies is still heterogeneous, ranging from prospective randomised trials [ 16 , 112 , 230 , 260 ] and large registry-based studies [ 153 , 158 , 200 ] to small case series or case reports. In addition, these therapies have a vast range of applications and are primarily used in combination or as part of sequential multimodal strategies, thus making it challenging to conduct informative comparative trials.…”

“…Despite no convincing evidence compared with standard surgical excision, ECT can still be considered an opportunity to avoid the morbidity of surgical resection in selected patients. To this aim, treatment naïvety, no previous radiation, and the ability to cover tumour margins may inform patient choice [ 158 ].…”

Eletroquimioterapia Como Opção De Tratamento Para Carcinoma Basocelular

“…Nos últimos 20 anos, a eletroquimioterapia tem sido aplicada principalmente em um ambiente paliativo, permitindo o controle de sangramentos e sintomas relacionados à massa. (Peris et al, 2023) As indicações de eletroquimioterapia propostas no estudo podem ser resumidas da seguinte forma: tratamento de CBC de baixo risco em subgrupos estritamente selecionados, impróprios para tratamento cirúrgico por causa de sua idade ou comorbidades; tratamento de preservação de órgãos de CBC de pequeno porte de alto risco localizado em áreas anatômicas delicadas, como na pálpebra, nariz e aurícula em pacientes que não estão aptos ou se encontram dispostos a preservar o funcionamento do paciente; tratamento auxiliar de CBC localmente avançado em conjunto com o tratamento sistêmico (Bertino et al, 2022).…”