Basal cell carcinoma and electrochemotherapy

Published Date: 12th March 2019

Publication Authors: Liew S

Background

Basal cell carcinoma(BCC) is one of the most common skin malignancies worldwide. In comparison to current management strategies for BCC, electrochemotherapy (ECT) proved to be a valid alternative in the management of primary and secondary lesions. ECT refers to intratumoural or intravenous injection of bleomycin followed by the delivery of electric pulses to the tumour area under local or general anaesthesia. The International Network for Sharing Practice on Electrochemotherapy(InspECT) database was analysed with the aim to understand if ECT is safe and effective in the treatment of BCC of the skin and mucous membranes.

Materials and Methods

We performed a multicentre retrospective analysis of prospectively collected data from the InspECT database of 277 patients from 14 European centres affected by basal cell carcinoma who underwent ECT. Of the total number of patients analysed, 246 patients with a follow-up period above 2 months were included in the study for a total of 466 nodules studied.

Results

Six patients were not evaluable due to lost follow-up, death (unrelated to treatment), other treatment, or unable/unwilling to continue control. 240 patients were evaluable for tumour response according to lesion presentation (primary vs secondary), size of the lesion, previous treatments, pain score and side-effects. We found an objective response (complete response plus partial response) of 93.8% per patient, and 95.2% per nodule, with a complete response of 79.2% and 81.5% respectively. Primary presentation (p=0.0035) and smaller nodules <=3 cm (p=0.0009) which were not previously treated (p=0.0003) or preirradiated (p<0.0001) were associated with higher complete response rates. Multivariate analysis further confirmed these results. Ulceration and hyperpigmentation were found to be the most common side effects, whilst pain intensity after the ECT session (p=0.036) and during follow-up (p=0.0015) remained significantly low.The one-year local progression free survival was 94%; 21 patients (8.5%) had a recurrence or a post-treatment local progression within a median of 312 days.

Conclusion

Data extrapolated from the InspECT analysis suggest that ECT is a safe and effective treatment in patients with BCC; the evidence that tumour response is significantly higher in small, primary and not previously treated nodules could lead to ECT being considered as a first-line treatment option in selected cases, such as the elderly or other patients not suited to standard therapies.

 

Bertino, G; Liew, SH et al. (2019). Basal cell carcinoma and electrochemotherapy: the InspECT experience . European Journal of Surgical Oncology. 45 (2), e4-5

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