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Campana LG, Miklavčič D, Bertino G, Marconato R, Valpione S, Imarisio I, Dieci MV, Granziera E, Cemazar M, Alaibac M, Sersa G. Electrochemotherapy of superficial tumors - Current status:: Basic principles, operating procedures, shared indications, and emerging applications. Semin Oncol 2019; 46:173-191. [PMID: 31122761 DOI: 10.1053/j.seminoncol.2019.04.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 12/18/2022]
Abstract
Treatment of superficial tumors with electrochemotherapy (ECT) has shown a steep rise over the past decade and indications range from skin cancers to locally advanced or metastatic neoplasms. Based on reversible electroporation, which is a physical method to achieve transient tumor cell membrane permeabilization by means of short electric pulses, ECT increases cellular uptake of bleomycin and cisplatin and their cytotoxicity by 8,000- and 80-fold, respectively. Standard operating procedures were established in 2006 and updated in 2018. Ease of administration, patient tolerability, efficacy across histotypes, and repeatability are peculiar advantages, which make standard ECT (ie, ECT using fixed-geometry electrodes) a reliable option for controlling superficial tumor growth locally and preventing their morbidity. Consolidated indications include superficial metastatic melanoma, breast cancer, head and neck skin tumors, nonmelanoma skin cancers, and Kaposi sarcoma. In well-selected patients with oropharyngeal cancers, ECT ensures appreciable symptom control. Emerging applications include skin metastases from visceral or hematological malignancies, vulvar cancer, and some noncancerous skin lesions (keloids and capillary vascular malformations). Repeatability and integration with other oncologic therapies allow for consolidation of response and sustained tumor control. In this review, we present the basic principles of ECT, recently updated operating procedures, anesthesiological management, and provide a synthesis of the efficacy of standard ECT across histotypes.
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Affiliation(s)
- Luca G Campana
- Department of Surgery Oncology and Gastroenterology (DISCOG), University of Padua, Italy; Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
| | - Damijan Miklavčič
- University of Ljubljana, Faculty of Electrical Engineering, Ljubljana, Slovenia
| | - Giulia Bertino
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | | | - Ilaria Imarisio
- Medical Oncology Unit, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Maria Vittoria Dieci
- Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy; Medical Oncology-2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Elisa Granziera
- Anesthesiology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Mauro Alaibac
- Dermatology, Department of Medicine, University of Padua, Padua, Italy
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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