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

Abstract

Background. Electrochemotherapy (ECT) can be performed on tumors in patients that precedes tumor irra-diation 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 methods. For 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 RT as before ECT (ECT → RT) or ECT as before RT (RT → ECT), in both cases because the first treatment resulted in non-complete response. In the case of ECT → RT the time interval was 5.3 months and in the case of RT → ECT 7.6 months. The minimal time interval between the treatments was 1 month.
Results. Treatment 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 predomi-nantly on older population of patients with the age range from 59 to 96 years, median over 80 years. Im-portantly, 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 88% objective responses. In contrast, the RT → ECT group had a significantly lower rate, with 58% objective responses. Long-term re-sponses, measured at 2-years follow-up by progression-free survival, were also significantly higher in the ECT → RT group (68%) compared to the RT → ECT group (20%). This resulted also in significantly higher overall progression free survival in ECT → RT group (p = 0.0232).
Conclusions. The 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.