Electrochemotherapy for cutaneous tumors combined with tumor irradiation before or after treatment: feasibility, safety, and effectiveness.

backgroundElectrochemotherapy (ECT) can be performed on tumors in patients that precedes tumor irradiation or on recurrent tumors after tumor irradiation. In this study we evaluated the feasibility, safety and effectiveness of the combined ECT and tumor irradiation (radiotherapy, RT) on different tumors in the head and neck region. PATIENTS AND

methodsFor the present cohort analysis, patients were selected from the Insp-ECT database, based on the following criteria: presence of head and neck lesions of any histological origin, treatment with both ECT and RT in any sequence, and a maximum interval of 12 months between the two treatments. The patients were treated with ECT followed by RT (ECT → RT) or RT followed by ECT (RT → ECT), in both cases because the first treatment resulted in incomplete response or subsequent relapse. In the case of ECT → RT the meantime interval was 5.7 months and in the case of RT → ECT 7.6 months. The minimal time interval between the treatments was 1 month.

resultsTreatment with ECT with bleomycin was feasible in all patients, treated either before or after RT. Included were 37 patients with the head and neck lesions. The combined treatment was performed predominantly on older population of patients with the age range from 50 to 96 years, median over 80 years. Importantly, in the group ECT → RT the major reason for RT was partial response (67%) after ECT. While, in the RT → ECT group the major reason for subsequent ECT was 58% of stable or progressive disease (failure to treatment). In both groups local symptoms decreased, like ulceration, odour and suppuration of tumors. In the ECT → RT group, the short-term response after 2 months was high, with 89% objective responses. In contrast, the RT → ECT group had a significantly lower rate, with 58% objective responses. At 24-month progression free survival (PFS) was 68% in the ECT → RT group and 20% in the RT → ECT group (p = 0.0101). The overall progression free survival Kaplan-Meier curves also differed significantly (log-rank p = 0.0232).

conclusionsThe combined treatment of ECT and RT is feasible, safe, and effective in elderly patients. The findings suggest that ECT may have particular value as a neoadjuvant treatment before RT, especially for bulky, ulcerated, or symptomatic lesions in this population.