Health-related quality of life trajectories in melanoma patients after electrochemotherapy: real-world insights from the InspECT register

BACKGROUND

Electrochemotherapy (ECT) effectively controls skin metastases from cutaneous melanoma.

OBJECTIVES

This study aimed to evaluate health-related quality of life (HRQoL) in melanoma patients pre-/post-ECT and its effect on treatment outcome.

METHODS

The analysis included prospective data from the International Network for Sharing Practices of ECT register. Following the Standard Operating Procedures, patients received intravenous or intratumoural bleomycin (15,000 IU/m2 ; 1000 IU mL/cm3 ) followed by 100-microsecond, 1000-V/cm electric pulses. Endpoints included response (RECIST v3.0), local progression-free survival (LPFS), toxicity (CTCAE v5.0), and patient-reported HRQoL at baseline, one, two, four and ten months (EuroQol [EQ-5D-3L], including 5-item utility score [EQ-5D] and visual analogue scale for self-reported health state [EQ-VAS]). Comparisons within/between subgroups were made for statistical and minimal important differences (MID). HRQoL scores and clinical covariates were analysed to identify predictors of response in multivariate analysis.

RESULTS

Median tumour size was 2 cm. Complete response rate, G3 toxicity and one-year LPFS in 378 patients (76% of the melanoma cohort) were 47%, 5%, and 78%. At baseline, age-paired HRQoL did not differ from the general European population. Following ECT, both EQ-5D and EQ-VAS scores remained within MID boundaries, particularly among complete responders. A subanalysis of the EQ-5D items revealed a statistically significant deterioration in pain/discomfort and mobility (restored within four months), and self-care and usual activities (throughout the follow-up) domains. Concomitant checkpoint inhibition correlated with better EQ-5D and EQ-VAS trajectories. Baseline EQ-5D was the exclusive independent predictor for complete response (RR 14.76, p=0.001).

CONCLUSIONS

HRQoL of ECT melanoma patients parallels the general population and is preserved in complete responders. Transient deterioration in pain/discomfort and mobility and persistent decline in self-care and usual activities may warrant targeted support interventions. Combination with checkpoint inhibitors is associated with better QoL outcomes. Baseline HRQoL provides predictive information which can help identify patients most likely to respond.

Hidradenitis suppurativa (Acne inversa) – Aktuelles zu Komorbidität und Therapie

Lange unter der Rubrik „orphan disease“ gelistet, erfuhr die Hidradenitis suppurativa (HS) zuletzt mit der Zulassung von Adalimumab neue Aufmerksamkeit. Was mit einzelnen Knoten und Abszessen anfängt, endet unter mangelnder Behandlung nicht selten in ausgedehnter Fistelbildung und Vernarbung, die zum Teil mit erheblichen Bewegungseinschränkungen, sozialem Rückzug und Isolation einhergehen.

In Deutschland geht man derzeit von einer Prävalenz von etwa 1 % aus 1 2. Somit kommt diese multifaktoriell bedingte Erkrankung ähnlich häufig vor wie die Psoriasis, doch bekommt sie bei weitem nicht die gleiche Aufmerksamkeit. Vielleicht ist dies auch der Tatsache geschuldet, dass das Therapieangebot mit (noch) nur einer zugelassenen medikamentösen Therapie (Adalimumab) sehr viel kleiner ausfällt als beispielsweise das der Psoriasis.

[Adnexal skin tumors, gigantic dimensions]

Adnexal skin tumors are rare and mostly not common. Their appearance are atypical and only histologically to save. 2 cases were demonstrated with impressing extension demanding a complex surgical approach.

[The distally pedicled suralis flap for the defect coverage of posttraumatic and chronic soft-tissue lesions in the "critical" lower leg]

Vascular diseases and/or sequelae of various systemic diseases are frequently associated with therapy-resistant soft tissue lesions in the lower extremity. Neurovascular pedicled island flaps without the need for the sacrifice of major vessels offer the possibility to save the lower limb from amputation. The long pedicle allows for a wide, tension-free arc of rotation. Major studies of clinical applications at the critical lower extremity have not been reported yet. 14 patients with chronic ulcerations in problematic areas (e.g. ankle, tibia) underwent definitive reconstruction using this flap. Complications were mostly observed at the donor site. In one patient major amputation was necessary due to the development of sepsis. In all other cases adequate coverage and limb salvage was achieved. Excellent padding, variable size and the modest nature of the flap enlarges the variety of plastic-reconstructive procedures in the lower extremity.

Salvage of an avascular thumb by arteriovenous flow reversal and a microvascular "kite" flap: case report

This case report describes the salvage of an avascular thumb by retrograde venous arterialization. The thumb survived with a 30 percent tissue loss at the radial aspect. Soft-tissue reconstruction and contour correction were achieved with a new microvascular free flap--the free "kite" flap--from the contralateral index finger. Aesthetic and functional results were excellent, and the patient returned to his original occupation. It can be concluded that retrograde arterialization can provide successful salvage in replantation and revascularization under favorable circumstances.

[Plastic surgery concepts for coverage of extremity defects within the scope of general surgery]

Soft tissue defects of the extremities are infrequent within the spectrum of general surgery and are predominantly found with perfusion disorders of macro- and microcirculation in the lower extremities. In the upper extremity, they are more frequently seen after i.v. cytostatic drug administration and tumor resections. This article describes the most frequent causes of complex defects of the extremities. Common flaps for the reconstruction of these defects and the pathway to decision making are elucidated.