Electrochemotherapy as an adjunct to the surgical management of metastatic melanoma

Published Date: 12th March 2019

Publication Authors: Liew S

Background

Electrochemotherapy is a treatment for tumours in the skin, both primary and metastatic. The international Network for sharing practices on Electrochemotherapy (InspECT) group gathers information on treatment outcomes in a common database with defined, outcome parameters in order to improve and guide the use of Electrochemotherapy (ECT). Over a period of 10 years we have investigated the effectiveness of ECT in cutaneous melanoma metastasis and identified factors which affect the outcome.

Methods

20 treatment centers across Europe have treated and uploaded melanoma data to the InspECT database. Patients were given intratumoural or intravenous Bleomycin followed by the application of electric pulses to the tumour nodules, under local or general anaesthesia. Up to 7 tumor lesions were registered for each patient. Response rates were investigated in relation to tumour size, choice of electrode type, and route of bleomycin administration, as well as previous irradiation to the treated lesions.

Results

246 patients with metastatic melanoma were identified from the database, 203 of which had follow-up data of 60 days or more. 161 of these patients (80 %) experienced an overall response (complete response + partial response = OR). 679 lesions were treated, with an overall response seen in 571 lesions (84 %), and a complete response seen in 453 lesions (67 %). In multivariate analysis, factors positively associated with overall response were coverage of deep margins, absence of visceral metastases, presence of lymphoedema, and treatment of non-irradiated areas. These factors significantly influenced treatment efficacy. Factors significant associated with a complete response to ECT treatment were: coverage of deep margins, previous irradiation of treated area, and tumour size (<3 cm). One-year overall survival in this cohort of patients was 67% (C.I. 95%: 57%-77%), whilst melanoma specific survival was 74% (C.I. 95%: 64%-84%). No serious adverse events were reported, and the treatment was in general very well tolerated.

Conclusion

ECT is a highly effective local treatment for cutaneous melanoma metastases, with no severe adverse effects. In the presence of certain clinical factors, ECT may be considered for local tumour control as an alternative to established local treatments, or as an adjunct to systemic treatments.

 

Odili, J; Liew, SW et al. (2019). Electrochemotherapy as an adjunct to the surgical management of metastatic melanoma: experience of the inspECT group (2008 to 2018). European Journal of Surgical Oncology. 45 (2), e5-6

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