1
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Guo F, Luo Z, Zhou W. Considering Joule heating in coupled electroporation and electrodeformation modeling of glioblastoma cells. Comput Biol Med 2024; 177:108678. [PMID: 38833796 DOI: 10.1016/j.compbiomed.2024.108678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
Cells exposed to a pulsed electric field undergo electroporation(EP) and electrodeformation(ED) under electric field stress, and a coupled model of EP and ED of glioblastoma(GBM) taking into account Joule heating is proposed. The model geometry is extracted from real cell boundaries, and the effects of Joule heating-induced temperature rise on the EP and ED processes are considered. The results show that the temperature rise will increase the cell's local conductivity, leading to a decrease in the transmembrane potential(TMP). The temperature rise also causes a decrease in the dynamic Young's modulus of the cell membrane, making the cell less resistant to deformation. In addition, GBM cells are more susceptible to EP in the middle portion of the cell and ED in the three tentacle portions under pulsed electric fields, and the cells undergo significant positional shifts. The ED of the nucleus is similar to spherical cells, but the degree of ED is smaller.
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Affiliation(s)
- Fei Guo
- Institute of Ecological Safety, Chongqing University of Posts and Telecommunications, Chongqing, 400065, China.
| | - Zhijun Luo
- Institute of Ecological Safety, Chongqing University of Posts and Telecommunications, Chongqing, 400065, China
| | - Weina Zhou
- Institute of Ecological Safety, Chongqing University of Posts and Telecommunications, Chongqing, 400065, China
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2
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Ramos SC, Dias-Pereira P, Luís AL, MacFarlane M, Santos AA. Electrochemotherapy in dogs and cats-A review. Vet Comp Oncol 2024. [PMID: 38866596 DOI: 10.1111/vco.12980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 06/14/2024]
Abstract
Electrochemotherapy (ECT) is a treatment modality that combines the electroporation of cell membranes with chemotherapy to facilitate the transport of non-permeant molecules into cells. Several canine and feline studies have shown promising results, suggesting that ECT can be a valid adjuvant or alternative treatment option for some tumours. The objective of this paper is to provide a bibliographic review of the principles and applications of ECT in veterinary medicine and to compare to its use in human medicine.
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Affiliation(s)
| | | | - Ana Lúcia Luís
- Institute of Biomedical Sciences Abel Salazar, Porto, Portugal
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Bertino G, Minuti M, Groselj A, Jamsek C, Silvestri B, Carpene S, Matteucci P, Riva G, Pecorari G, Mascherini M, Kjær Lønkvist C, Muir T, Kunte C, de Terlizzi F, Sersa G. Electrochemotherapy (ECT) in treatment of mucosal head and neck tumors. An international network for sharing practices on ECT (InspECT) study group report. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108473. [PMID: 38870873 DOI: 10.1016/j.ejso.2024.108473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/23/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024]
Abstract
The aim of this multicenter study was to evaluate the effectiveness and safety of electrochemotherapy (ECT) for the treatment of mucosal tumors in the head and neck. A total of 71 patients with 84 nodules of different histologies in the oral cavity, pharynx and larynx treated by ECT were evaluated. The data were collected from the InspECT database from 10 participating centers throughout Europe. Primary and recurrent/secondary tumors of different histologies were treated. The overall response rate was 65 %, with a 33 % complete response rate with limited side effects. The response rates of the primary and secondary tumors were not different. However, smaller tumors responded better than tumors larger than 3 cm in diameter. Furthermore, the tumors that were treated with curative intent responded significantly better than those treated with palliative intent. This study demonstrated the feasibility, safety and effectiveness of ECT in a larger cohort of patients with mucosal lesions in the head and neck region. Based on the available data, ECT can be used for the treatment of recurrent and, in some cases, primary mucosal tumors located in the oral cavity, larynx, and pharynx. A better response was obtained in patients with smaller primary tumors treated with curative intent.
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Affiliation(s)
- Giulia Bertino
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Policlinico San Matteo Foundation, 27100, Pavia, Italy.
| | - Marta Minuti
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Policlinico San Matteo Foundation, 27100, Pavia, Italy
| | - Ales Groselj
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloska 2, 1000, Ljubljana, Slovenia.
| | - Crt Jamsek
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloska 2, 1000, Ljubljana, Slovenia.
| | - Barbara Silvestri
- Oncology and Haematology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima - Ospedale di Mirano, Venice, Italy.
| | - Silvia Carpene
- Otolaryngology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima - Ospedale di Mirano, Venice, Italy.
| | - Paolo Matteucci
- Department of Plastic Surgery, Hull University Teaching Hospitals National Health Service (NHS) Trust, Hull, UK.
| | - Giuseppe Riva
- Department of Surgical Sciences, Otolaryngology Clinic, University of Turin, Turin, Italy.
| | - Giancarlo Pecorari
- Department of Surgical Sciences, Otolaryngology Clinic, University of Turin, Turin, Italy.
| | - Matteo Mascherini
- Department of Surgical Sciences, IRCCS Polyclinic Hospital San Martino, Genoa, Italy.
| | - Camilla Kjær Lønkvist
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, 2730, Herlev, Denmark.
| | - Tobian Muir
- Department of Plastic Surgery, South Tees NHS Foundation Trust, Middlesbrough TS4 3BW, UK.
| | - Christian Kunte
- Department of Dermatosurgery and Dermatology, Artemed Fachklinik Munich, München, Germany.
| | | | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia.
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Qian K, Wang Y, Lei Y, Yang Q, Yao C. An experimental and theoretical study on cell swelling for osmotic imbalance induced by electroporation. Bioelectrochemistry 2024; 157:108637. [PMID: 38215652 DOI: 10.1016/j.bioelechem.2023.108637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/02/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024]
Abstract
The cellular membrane serves as a pivotal barrier in regulating intra- and extracellular matter exchange. Disruption of this barrier through pulsed electric fields (PEFs) induces the transmembrane transport of ions and molecules, creating a concentration gradient that subsequently results in the imbalance of cellular osmolality. In this study, a multiphysics model was developed to simulate the electromechanical response of cells exposed to microsecond pulsed electric fields (μsPEFs). Within the proposed model, the diffusion coefficient of the cellular membrane for various ions was adjusted based on electropore density. Cellular osmolality was governed and described using Van't Hoff theory, subsequently converted to loop stress to dynamically represent the cell swelling process. Validation of the model was conducted through a hypotonic experiment and simulation at 200 mOsm/kg, revealing a 14.2% increase in the cell's equivalent radius, thereby confirming the feasibility of the cell mechanical model. With the transmembrane transport of ions induced by the applied μsPEF, the hoop stress acting on the cellular membrane reached 179.95 Pa, and the cell equivalent radius increased by 11.0% when the extra-cellular medium was supplied with normal saline. The multiphysics model established in this study accurately predicts the dynamic changes in cell volume resulting from osmotic imbalance induced by PEF action. This model holds theoretical significance, offering valuable references for research on drug delivery and tumor microenvironment modulation.
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Affiliation(s)
- Kun Qian
- State Key Laboratory of Power Transmission Equipment Technology, School of Electrical Engineering, Chongqing University, No.174 Shazhengjie Road, Chongqing 400044, China
| | - Yancheng Wang
- State Key Laboratory of Power Transmission Equipment Technology, School of Electrical Engineering, Chongqing University, No.174 Shazhengjie Road, Chongqing 400044, China
| | - Yizhen Lei
- State Key Laboratory of Power Transmission Equipment Technology, School of Electrical Engineering, Chongqing University, No.174 Shazhengjie Road, Chongqing 400044, China
| | - Qiang Yang
- State Key Laboratory of Power Transmission Equipment Technology, School of Electrical Engineering, Chongqing University, No.174 Shazhengjie Road, Chongqing 400044, China
| | - Chenguo Yao
- State Key Laboratory of Power Transmission Equipment Technology, School of Electrical Engineering, Chongqing University, No.174 Shazhengjie Road, Chongqing 400044, China.
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Vivod G, Omerzel M, Kovacevic N, Gasljevic G, Cilensek I, Sersa G, Cemazar M, Merlo S. Treatment of vulvar cancer recurrence with electrochemotherapy: a case-control study. Acta Oncol 2024; 63:351-357. [PMID: 38770722 DOI: 10.2340/1651-226x.2024.33241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/05/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Electrochemotherapy (ECT) is a combined treatment method based on electroporation and simultaneous chemotherapy. In cases where radiotherapy has previously been used, surgery is often the only treatment option for vulvar cancer recurrence with potential resection of clitoris, vagina, urethra or anal sphincter. The unique advantage of ECT is its selectivity for cancer cells while sparing the surrounding healthy tissue. The aim of the study was to compare the ECT treatment of vulvar cancer recurrence for non-palliative purposes with surgical treatment. MATERIALS AND METHODS Eleven patients with single vulvar cancer recurrence were treated with ECT and followed up for 12 months. As a control group, 15 patients with single vulvar cancer recurrence were treated with wide local excision. The following data were collected, analyzed and compared: Age, body mass index, comorbidities, histological type, location and size of vulvar cancer recurrence, treatment history, details of procedures and hospital stay. RESULTS The probability curves for local tumor control did not differ between the ECT group and the surgical group (p = 0.694). The mean hospital stay and the mean duration of procedure were statistically significantly shorter in the ECT group (p < 0.001). There were no statistically significant differences between the ECT and surgical groups in terms of mean body mass index, associated diseases, previous treatments, presence of lichen sclerosus, p16 status, gradus, anatomical site of the tumor, and type of anesthesia. CONCLUSION In this case-control study, treatment of vulvar cancer recurrence with ECT for non-palliative purposes was comparable to surgical treatment in terms of effectiveness. The results need to be confirmed in larger randomized trials.
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Affiliation(s)
- Gregor Vivod
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Masa Omerzel
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Nina Kovacevic
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Gorana Gasljevic
- Department of Pathology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Ines Cilensek
- Institute of Histology and Embryology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; University of Ljubljana, Faculty of Health Sciences, Ljubljana, Slovenia
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Sebastjan Merlo
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Wu Z, Tao C, Yang L, Yan Y, Pan L, Zhang L. Treatment benefit of electrochemotherapy for superficial squamous cell carcinoma: a systematic review and single-arm meta-analysis. Clin Transl Oncol 2024:10.1007/s12094-024-03522-4. [PMID: 38758386 DOI: 10.1007/s12094-024-03522-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE Treating aggressive superficial squamous cell carcinoma (SCC) poses challenges due to invasiveness. Palliative care is recommended for inoperable cases with extensive tumors near vital organs, risking disfigurement or functional impairment. Electrochemotherapy (ECT) is an emerging cutaneous tumor treatment, but its efficacy against superficial SCC remains uncertain. This study conducts a systematic review and single-arm meta-analysis to evaluate ECT's effectiveness against superficial SCC and provide current evidence for clinical practice. METHODS Embase, PubMed and Cochrane Library were searched for studies up to May 2023. The random effects model analyzed complete response (CR) and partial response (PR), with subgroup assessment based on drug dosage, treatment response evaluation, tumor size, primary/recurrent status, and tumor location. RESULTS Ten studies involving 162 patients and 208 tumors were included. Pooled CR and PR rates for ECT-treated superficial SCC were 66.5% (95% CI 48.4%-82.5%; I2 = 84%) and 20.3% (95% CI 10.5%-32.3%; I2 = 70%), respectively. Subgroup analysis indicated ECT's superiority in treating primary tumors (PR: 70%, CR: 30%) and tumors ≤ 3 cm (PR: 81.3%, CR: 10.1%) compared to recurrent tumors (PR: 56.7%, CR: 36.5%) and tumors > 3 cm (PR: 45.2%, CR: 34.4%). CONCLUSION This single-arm meta-analysis confirms ECT's efficacy against superficial SCC, especially in primary tumors and those ≤ 3 cm in diameter. The study highlights the impact of tumor location and response evaluation on ECT's benefits, warranting further investigation through additional research.
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Affiliation(s)
- Zhuoxia Wu
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
| | - Chen Tao
- School of Mathematics and Statistics, Northeast Normal University, Changchun, 130024, Jilin, China.
| | - Liehao Yang
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
| | - Yan Yan
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
| | - Lingfeng Pan
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
| | - Lianbo Zhang
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China
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Carpenè S, Silvestri B, Bertinazzi M, Armato E, Amadori M, Spinato R, de Terlizzi F, Azzarello G. Electrochemotherapy as adjuvant treatment in a sinonasal mucosal melanoma in elderly patient: a case report. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08606-z. [PMID: 38634895 DOI: 10.1007/s00405-024-08606-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/29/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Sinonasal Mucosal Melanoma (SNMM) is a rare but aggressive disease. Surgery with free margins, when feasible, is the treatment of choice. In the last three decades, electrochemotherapy (ECT) has emerged as a local ablative procedure, performed with the Cliniporator, for cutaneous and mucosal tumours of different histology. We present a case report of an ECT treatment performed by means of a new endoscopic electrode, on an elderly patient affected by primary SNMM. METHODS An 88-year-old man with a diagnosis of SNMM (cT4aN0M0)-Stage IV, of the left nasal fossa presented at our institution. Symptoms were epistaxis and complete left nasal obstruction. He refused sinonasal extended surgery and radiotherapy. He underwent a tumor debulking followed by ECT exclusively for symptom control, with palliative intent. RESULTS The patient underwent SNMM debulking under general anaesthesia, followed by ECT on tumour margins. After the procedure, he had been free from symptoms for 5 months, with a good quality of life. Local recurrence was controlled with a new local debulking and ECT procedure on margins. The patient remained symptom free for the next 4 months. Seventeen months after diagnosis, the patient is mild symptomatic for sinonasal disease. Therefore, he developed a systemic disease progression. CONCLUSIONS In our experience, ECT can be used as an adjuvant tool for symptom and local control in SNMM when extended surgery is out of curative intent or unfeasible. As expected, ECT does not appear to have any effect on systemic disease progression.
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Affiliation(s)
- Silvia Carpenè
- Otolaryngology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima - Ospedale di Mirano, Venice, Italy
| | - Barbara Silvestri
- Oncology and Haematology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima - Ospedale di Mirano, Venice, Italy.
| | - Martina Bertinazzi
- Otolaryngology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima - Ospedale di Mirano, Venice, Italy
| | - Enrico Armato
- Otolaryngology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima - Ospedale di Mirano, Venice, Italy
| | - Maurizio Amadori
- Otolaryngology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima - Ospedale di Mirano, Venice, Italy
| | - Roberto Spinato
- Otolaryngology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima - Ospedale di Mestre, Venice, Italy
| | | | - Giuseppe Azzarello
- Oncology and Haematology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima - Ospedale di Mirano, Venice, Italy
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Schmidt VF, Cangir Ö, Meyer L, Goldann C, Hengst S, Brill R, von der Heydt S, Waner M, Puhr-Westerheide D, Öcal O, Ümütlü MR, Mansour N, Rudolph J, Sint A, Obereisenbuchner F, Häberle B, Ricke J, Seidensticker M, Wohlgemuth WA, Wildgruber M. Outcome of bleomycin electrosclerotherapy of slow-flow malformations in adults and children. Eur Radiol 2024:10.1007/s00330-024-10723-6. [PMID: 38627287 DOI: 10.1007/s00330-024-10723-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/19/2024] [Accepted: 03/01/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES To evaluate the safety and clinical outcome of bleomycin electrosclerotherapy (BEST) for treating extracranial slow-flow malformations. METHODS In this retrospective investigation of a multicenter cohort presenting symptomatic slow-flow malformations, patient records were analyzed with respect to procedural details and complications. A treatment-specific, patient-reported questionnaire was additionally evaluated, obtained 3-12 months after the last treatment, to assess the subjective outcomes, including mobility, aesthetic aspects, and pain, as well as the occurrence of postprocedural skin hyperpigmentation. All outcome parameters were compared according to patients' age. RESULTS Overall, 325 BEST treatments were performed in 233 patients after intralesional and/or intravenous bleomycin injection. The total complication rate was 10.2% (33/325), including 29/352 (8.9%) major complications. Patient-reported mobility decreased in 10/133 (8.8%), was stable in 30/113 (26.5%), improved in 48/113 (42.5%), and was rated symptom-free in 25/113 (22.1%) patients. Aesthetic aspects were rated impaired compared to baseline in 19/113 (16.8%), stable in 21/133 (18.6%), improved in 62/113 (54.9%), and perfect in 11/133 (9.7%) patients. Postprocedural skin hyperpigmentation occurred in 78/113 (69%) patients, remaining unchanged in 24/78 (30.8%), reduced in 51/78 (65.5%), and completely resolved in 3/78 (3.8%) patients. The median VAS pain scale was 4.0 (0-10) preprocedural and 2.0 (0-9) postprocedural. Children/adolescents performed significantly better in all parameters compared to adults (≥ 16 years) (mobility, p = 0.011; aesthetic aspects, p < 0.001; pain, p < 0.001). CONCLUSIONS BEST is effective for treating slow-flow vascular malformations, with few but potentially significant major complications. Regarding patient-reported outcomes, children seem to benefit better compared to older patients, suggesting that BEST should not be restricted to adults. CLINICAL RELEVANCE STATEMENT Bleomycin electrosclerotherapy is a safe and effective approach and therapy should not be restricted to adults due to good clinical outcomes in children.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology, LMU University Hospital, LMU Munich, München, Germany.
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA), LMU University Hospital, LMU Munich, München, Germany.
| | - Özlem Cangir
- Department of Pediatric Surgery, Center for Vascular Malformations, Klinikum Barnim GmbH, Werner Forssmann Hospital, Eberswalde, Germany
| | - Lutz Meyer
- Department of Pediatric Surgery, Center for Vascular Malformations, Klinikum Barnim GmbH, Werner Forssmann Hospital, Eberswalde, Germany
| | - Constantin Goldann
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Susanne Hengst
- Department of Radiology, Center for Vascular Malformations, Klinikum Barnim GmbH, Werner Forssmann Hospital, Eberswalde, Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Susanne von der Heydt
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Milton Waner
- Vascular Birthmark Institute of New York, New York, NY, USA
| | | | - Osman Öcal
- Department of Radiology, LMU University Hospital, LMU Munich, München, Germany
| | | | - Nabeel Mansour
- Department of Radiology, LMU University Hospital, LMU Munich, München, Germany
| | - Jan Rudolph
- Department of Radiology, LMU University Hospital, LMU Munich, München, Germany
| | - Alena Sint
- Department of Radiology, LMU University Hospital, LMU Munich, München, Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA), LMU University Hospital, LMU Munich, München, Germany
| | - Florian Obereisenbuchner
- Department of Radiology, LMU University Hospital, LMU Munich, München, Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA), LMU University Hospital, LMU Munich, München, Germany
| | - Beate Häberle
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA), LMU University Hospital, LMU Munich, München, Germany
- Department for Pediatric Surgery, LMU University Hospital, LMU Munich, München, Germany
| | - Jens Ricke
- Department of Radiology, LMU University Hospital, LMU Munich, München, Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA), LMU University Hospital, LMU Munich, München, Germany
| | - Max Seidensticker
- Department of Radiology, LMU University Hospital, LMU Munich, München, Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA), LMU University Hospital, LMU Munich, München, Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, LMU University Hospital, LMU Munich, München, Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA), LMU University Hospital, LMU Munich, München, Germany
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de Caro A, Talmont F, Rols MP, Golzio M, Kolosnjaj-Tabi J. Therapeutic perspectives of high pulse repetition rate electroporation. Bioelectrochemistry 2024; 156:108629. [PMID: 38159429 DOI: 10.1016/j.bioelechem.2023.108629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
Electroporation, a technique that uses electrical pulses to temporarily or permanently destabilize cell membranes, is increasingly used in cancer treatment, gene therapy, and cardiac tissue ablation. Although the technique is efficient, patients report discomfort and pain. Current strategies that aim to minimize pain and muscle contraction rely on the use of pharmacological agents. Nevertheless, technical improvements might be a valuable tool to minimize adverse events, which occur during the application of standard electroporation protocols. One recent technological strategy involves the use of high pulse repetition rate. The emerging technique, also referred as "high frequency" electroporation, employs short (micro to nanosecond) mono or bipolar pulses at repetition rate ranging from a few kHz to a few MHz. This review provides an overview of the historical background of electric field use and its development in therapies over time. With the aim to understand the rationale for novel electroporation protocols development, we briefly describe the physiological background of neuromuscular stimulation and pain caused by exposure to pulsed electric fields. Then, we summarize the current knowledge on electroporation protocols based on high pulse repetition rates. The advantages and limitations of these protocols are described from the perspective of their therapeutic application.
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Affiliation(s)
- Alexia de Caro
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, Toulouse, France
| | - Franck Talmont
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, Toulouse, France
| | - Marie-Pierre Rols
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, Toulouse, France
| | - Muriel Golzio
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, Toulouse, France.
| | - Jelena Kolosnjaj-Tabi
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, Toulouse, France.
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Zamuner A, Dettin M, Dall'Olmo L, Campana LG, Mognaschi ME, Conconi MT, Sieni E. Development of 3D melanoma cultures on a hyaluronic acid-based scaffold with synthetic self-assembling peptides: Electroporation enhancement. Bioelectrochemistry 2024; 156:108624. [PMID: 38104458 DOI: 10.1016/j.bioelechem.2023.108624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 12/19/2023]
Abstract
Electrochemotherapy (ECT) with bleomycin is an effective antitumor treatment. Still, researchers are investigating new drugs and electroporation conditions to improve its efficacy. To this aim, in vivo assays are accurate but expensive and ethically questionable. Conversely, in vitro assays, although cheaper and straightforward, do not reflect the architecture of the biological tissue because they lack a tridimensional (3D) structure (as in the case of two-dimensional [2D] in vitro assays) or do not include all the extracellular matrix components (as in the case of 3D in vitro scaffolds). To address this issue, 3D in vitro models have been proposed, including spheroids and hydrogel-based cultures, which require a suitable low-conductive medium to allow cell membrane electroporation. In this study, a synthetic scaffold based on hyaluronic acid (HA) and self-assembling peptides (SAPs; EAbuK), condensed with a Laminin-derived adhesive sequence (IKVAV), is proposed as a reliable alternative. We compare SKMEL28 cells cultured in the HA-EAbuK-IKVAV scaffold to the control (HA only scaffold). Three days after seeding, the culture on the HA-EAbuK-IKVAV scaffold showed collagen production. SKMEL28 cells cultured on the HA-EAbuK-IKVAV scaffold started to be electroporated at 400 V/cm, whereas, at the same electric field intensity, those cultured on HA were not. As a reference, 2D experiments showed that electroporation of SKMEL28 cells starts at 600 V/cm using an electroporation buffer and at 800 V/cm in a culture medium, but with very low efficiency (<50 % of cells electroporated). 3D cultures on HA-EAbuK-IKVAV allowed the simulation of a more reliable microenvironment and may represent a valuable tool for studying electroporation conditions. Using Finite Element Analysis (FEA) to compute the transmembrane potential, we detected the influence of inhomogeneity of the extracellular matrix on electroporation effect. Our 3D cell culture electroporation simulations showed that the transmembrane potential increased when collagen surrounded the cells. Of note, in the collagen-enriched HA-EAbuK-IKVAV scaffold, EP was already improved at lower electric field intensities. This study shows the influence of the extracellular matrix on electric conductivity and electric field distribution on cell membrane electroporation and supports the adoption of more reliable 3D scaffolds in experimental electroporation studies.
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Affiliation(s)
- Annj Zamuner
- Padova University, Department of Civil, Environmental, and Architectural Engineering, via Marzolo, 9, 35131 Padova, Italy; Padova University, Department of Industrial Engineering, via Marzolo, 9, 35131 Padova, Italy
| | - Monica Dettin
- Padova University, Department of Industrial Engineering, via Marzolo, 9, 35131 Padova, Italy
| | - Luigi Dall'Olmo
- Padova University, Department of Surgery Oncology and Gastroenterology, DISCOG. Via Giustiniani 2, 35128 Padova, Italy; Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), via Gattamelata 64, 35128 Padova, Italy
| | - Luca Giovanni Campana
- Department of Surgery, Manchester University NHS Foundation Trust, Oxford Rd, M13 9WL, Manchester, UK
| | - Maria Evelina Mognaschi
- Pavia University, Department of Electrical, Computer and Biomedical Engineering, via Ferrata, 5, 21100 Padova, Italy
| | - Maria Teresa Conconi
- Padova University, Department of Pharmaceutical and Pharmacological Sciences, via Marzolo, 5, 35131 Padova, Italy
| | - Elisabetta Sieni
- University of Insubria, Department of theoretical and applied sciences, via Dunant, 3, 21100 Varese, Italy.
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11
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Spugnini EP, Condello M, Crispi S, Baldi A. Electroporation in Translational Medicine: From Veterinary Experience to Human Oncology. Cancers (Basel) 2024; 16:1067. [PMID: 38473422 DOI: 10.3390/cancers16051067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
Electroporation (EP) is a broadly accepted procedure that, through the application of electric pulses with appropriate amplitudes and waveforms, promotes the delivery of anticancer molecules in various oncology therapies. EP considerably boosts the absorptivity of targeted cells to anticancer molecules of different natures, thus upgrading their effectiveness. Its use in veterinary oncology has been widely explored, and some applications, such as electrochemotherapy (ECT), are currently approved as first-line treatments for several neoplastic conditions. Other applications include irreversible electroporation and EP-based cancer vaccines. In human oncology, EP is still mostly restricted to therapies for cutaneous tumors and the palliation of cutaneous and visceral metastases of malignant tumors. Fields where veterinary experience could help smooth the clinical transition to humans include intraoperative EP, interventional medicine and cancer vaccines. This article recapitulates the state of the art of EP in veterinary and human oncology, recounting the most relevant results to date.
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Affiliation(s)
| | | | - Stefania Crispi
- Institute of Biosciences and BioResources-UOS Naples CNR, Via P. Castellino 111, 80131 Naples, Italy
| | - Alfonso Baldi
- Biopulse Srl, 00144 Rome, Italy
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, Campania University "Luigi Vanvitelli", 81100 Caserta, Italy
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12
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Lopes LB, Pintarelli GB, Guedert R, Andrade DLLS, Antonio AC, Ramos CTS, da Silva JR, Rangel MMM, Suzuki DOH. Novel tetrapolar single-needle electrode for electrochemotherapy in bone cavities: Modeling, design and validation. Med Eng Phys 2024; 125:104120. [PMID: 38508798 DOI: 10.1016/j.medengphy.2024.104120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/12/2024] [Accepted: 02/14/2024] [Indexed: 03/22/2024]
Abstract
Electrochemotherapy is a cancer treatment in which local pulsed electric fields are delivered through electrodes. The effectiveness of the treatment depends on exposing the tumor to a threshold electric field. Electrode geometry plays an important role in the resulting electric field distribution, especially in hard-to-reach areas and deep-seated tumors. We designed and developed a novel tetrapolar single-needle electrode for proper treatment in bone cavities. In silico and in vitro experiments were performed to evaluate the electric field and electric current produced by the electrode. In addition, tomography images of a real case of nasal cavity tumor were segmented into a 3D simulation to evaluate the electrode performance in a bone cavity. The proposed electrode was validated and its operating range was set up to 650 V. In the nasal cavity tumor, we found that the electrode can produce a circular electric field of 3 mm with an electric current of 14.1 A at 500 V, which is compatible with electrochemotherapy standards and commercial equipment.
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Affiliation(s)
- Lucas B Lopes
- Institute of Biomedical Engineering, Federal University of Santa Catarina, Florianópolis, 88040-900, SC, Brazil.
| | - Guilherme B Pintarelli
- Institute of Biomedical Engineering, Federal University of Santa Catarina, Florianópolis, 88040-900, SC, Brazil; Department of Control and Automation Engineering, Federal University of Santa Catarina, Blumenau, 89036-004, SC, Brazil
| | - Raul Guedert
- Institute of Biomedical Engineering, Federal University of Santa Catarina, Florianópolis, 88040-900, SC, Brazil
| | - Daniella L L S Andrade
- Institute of Biomedical Engineering, Federal University of Santa Catarina, Florianópolis, 88040-900, SC, Brazil
| | - Afrânio C Antonio
- Institute of Biomedical Engineering, Federal University of Santa Catarina, Florianópolis, 88040-900, SC, Brazil
| | - Clara T S Ramos
- Institute of Biomedical Engineering, Federal University of Santa Catarina, Florianópolis, 88040-900, SC, Brazil
| | - Jéssica R da Silva
- Institute of Biomedical Engineering, Federal University of Santa Catarina, Florianópolis, 88040-900, SC, Brazil
| | | | - Daniela O H Suzuki
- Institute of Biomedical Engineering, Federal University of Santa Catarina, Florianópolis, 88040-900, SC, Brazil
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13
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Scuderi M, Dermol-Cerne J, Scancar J, Markovic S, Rems L, Miklavcic D. The equivalence of different types of electric pulses for electrochemotherapy with cisplatin - an in vitro study. Radiol Oncol 2024; 58:51-66. [PMID: 38378034 PMCID: PMC10878774 DOI: 10.2478/raon-2024-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Electrochemotherapy (ECT) is a treatment involving the administration of chemotherapeutics drugs followed by the application of 8 square monopolar pulses of 100 μs duration at a repetition frequency of 1 Hz or 5000 Hz. However, there is increasing interest in using alternative types of pulses for ECT. The use of high-frequency short bipolar pulses has been shown to mitigate pain and muscle contractions. Conversely, the use of millisecond pulses is interesting when combining ECT with gene electrotransfer for the uptake of DNA-encoding proteins that stimulate the immune response with the aim of converting ECT from a local to systemic treatment. Therefore, the aim of this study was to investigate how alternative types of pulses affect the efficiency of the ECT. MATERIALS AND METHODS We performed in vitro experiments, exposing Chinese hamster ovary (CHO) cells to conventional ECT pulses, high-frequency bipolar pulses, and millisecond pulses in the presence of different concentrations of cisplatin. We determined cisplatin uptake by inductively coupled plasma mass spectrometry and cisplatin cytotoxicity by the clonogenic assay. RESULTS We observed that the three tested types of pulses potentiate the uptake and cytotoxicity of cisplatin in an equivalent manner, provided that the electric field is properly adjusted for each pulse type. Furthermore, we quantified that the number of cisplatin molecules, resulting in the eradication of most cells, was 2-7 × 107 per cell. CONCLUSIONS High-frequency bipolar pulses and millisecond pulses can potentially be used in ECT to reduce pain and muscle contraction and increase the effect of the immune response in combination with gene electrotransfer, respectively.
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Affiliation(s)
- Maria Scuderi
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Janja Dermol-Cerne
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Janez Scancar
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
- Jožef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Stefan Markovic
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
- Jožef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Lea Rems
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Damijan Miklavcic
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
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14
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Tedesco G, Noli LE, Griffoni C, Ghermandi R, Facchini G, Peta G, Papalexis N, Asunis E, Pasini S, Gasbarrini A. Electrochemotherapy in Aggressive Hemangioma of the Spine: A Case Series and Narrative Literature Review. J Clin Med 2024; 13:1239. [PMID: 38592093 PMCID: PMC10932223 DOI: 10.3390/jcm13051239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: this case series and literature review aims to evaluate the efficacy and safety of electrochemotherapy in the management of aggressive spinal hemangiomas, presenting two distinct cases. (2) Methods: we present two cases of spinal aggressive hemangioma which were refractory to conventional treatments and underwent electrochemotherapy. Case 1 involves a 50-year-old female who presented with an aggressive spinal hemangioma of L1, who previously underwent various treatments including surgery, radio-chemotherapy, and arterial embolization. Case 2 describes a 16-year-old female with a T12 vertebral hemangioma, previously treated with surgery and stabilization, who faced limitations in treatment options due to her young age and the location of the hemangioma. (3) Results: in Case 1, electrochemotherapy with bleomycin was administered following the failure of previous treatments and resulted in the reduction of the lesion size and improvement in clinical symptoms. In Case 2, electrochemotherapy was chosen due to the risks associated with other treatments and was completed without any adverse events. Both cases demonstrated the potential of electrochemotherapy as a viable treatment option for spinal hemangiomas, especially in complex or recurrent cases. (4) Conclusions: electrochemotherapy with bleomycin is a promising treatment for aggressive spinal hemangiomas when conventional therapies are not feasible or have failed. Further research is needed to establish definitive protocols and long-term outcomes of electrochemotherapy in spinal hemangioma management.
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Affiliation(s)
- Giuseppe Tedesco
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Luigi Emanuele Noli
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche Bologna, Bellaria Hospital, 40139 Bologna, Italy;
| | - Cristiana Griffoni
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Riccardo Ghermandi
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.F.); (G.P.); (N.P.)
| | - Giuliano Peta
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.F.); (G.P.); (N.P.)
| | - Nicolas Papalexis
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.F.); (G.P.); (N.P.)
| | - Emanuela Asunis
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Stefano Pasini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Alessandro Gasbarrini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
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15
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Morozas A, Malyško-Ptašinskė V, Kulbacka J, Ivaška J, Ivaškienė T, Novickij V. Electrochemotherapy for head and neck cancers: possibilities and limitations. Front Oncol 2024; 14:1353800. [PMID: 38434679 PMCID: PMC10905418 DOI: 10.3389/fonc.2024.1353800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Head and neck cancer continues to be among the most prevalent types of cancer globally, yet it can be managed with appropriate treatment approaches. Presently, chemotherapy and radiotherapy stand as the primary treatment modalities for various groups and regions affected by head and neck cancer. Nonetheless, these treatments are linked to adverse side effects in patients. Moreover, due to tumor resistance to multiple drugs (both intrinsic and extrinsic) and radiotherapy, along with numerous other factors, recurrences or metastases often occur. Electrochemotherapy (ECT) emerges as a clinically proven alternative that offers high efficacy, localized effect, and diminished negative factors. Electrochemotherapy involves the treatment of solid tumors by combining a non-permeable cytotoxic drug, such as bleomycin, with a locally administered pulsed electric field (PEF). It is crucial to employ this method effectively by utilizing optimal PEF protocols and drugs at concentrations that do not possess inherent cytotoxic properties. This review emphasizes an examination of diverse clinical practices of ECT concerning head and neck cancer. It specifically delves into the treatment procedure, the choice of anti-cancer drugs, pre-treatment planning, PEF protocols, and electroporation electrodes as well as the efficacy of tumor response to the treatment and encountered obstacles. We have also highlighted the significance of assessing the spatial electric field distribution in both tumor and adjacent tissues prior to treatment as it plays a pivotal role in determining treatment success. Finally, we compare the ECT methodology to conventional treatments to highlight the potential for improvement and to facilitate popularization of the technique in the area of head and neck cancers where it is not widespread yet while it is not the case with other cancer types.
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Affiliation(s)
- Arnoldas Morozas
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre of Innovative Medicine, Vilnius, Lithuania
| | | | - Julita Kulbacka
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre of Innovative Medicine, Vilnius, Lithuania
- Department of Molecular and Cellular Biology, Wroclaw Medical University, Wroclaw, Poland
| | - Justinas Ivaška
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre of Innovative Medicine, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tatjana Ivaškienė
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre of Innovative Medicine, Vilnius, Lithuania
| | - Vitalij Novickij
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre of Innovative Medicine, Vilnius, Lithuania
- Faculty of Electronics, Vilnius Gediminas Technical University, Vilnius, Lithuania
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16
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Parisi S, Gambardella C, Iovino F, Ruggiero R, Lucido FS, Nesta G, Tolone S, Brusciano L, Fisone F, Mongardini FM, Cozzolino G, Della Corte CM, Napolitano S, Orditura M, Esposito R, Docimo L. Post-Irradiation Breast Angiosarcoma: All the Possible Treatments and Electrochemotherapy. Case Report and Literature Review. J Clin Med 2024; 13:567. [PMID: 38256700 PMCID: PMC10816174 DOI: 10.3390/jcm13020567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/27/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Breast angiosarcoma is a rare malignancy, accounting for less than 1% of all soft tissue cancers. It comprises primitive and secondary subtypes, such as radiogenic breast angiosarcoma (RAS). Despite multimodal treatment, angiosarcomas represent an incurable disease for many patients and a significant cause of deterioration in their quality of life. Surgery is a cornerstone in management, but high recurrence rates are reported. Electrochemotherapy (ECT) is a practicable locoregional treatment for patients with advanced angiosarcoma as part of a multimodal therapeutic strategy. The palliative benefits of ECT include optimal patient compliance, good local hemostasis control, and positive local responses. Since only 22 cases are described in the literature, we reported a rare case of RAS treated with ECT after a multidisciplinary approach, including Next Generation Sequencing (NGS). A literature review on the feasibility of ECT in RAS management was also performed.
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Affiliation(s)
- Simona Parisi
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Claudio Gambardella
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Francesco Iovino
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
- Department of Translational Medical Sciences, Division of General Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Roberto Ruggiero
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Francesco Saverio Lucido
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Giusiana Nesta
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Salvatore Tolone
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Luigi Brusciano
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Francesca Fisone
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Federico Maria Mongardini
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Giovanni Cozzolino
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Carminia Maria Della Corte
- Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via S. Pansini 5, 80131 Naples, Italy; (C.M.D.C.); (S.N.); (M.O.)
| | - Stefania Napolitano
- Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via S. Pansini 5, 80131 Naples, Italy; (C.M.D.C.); (S.N.); (M.O.)
| | - Michele Orditura
- Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via S. Pansini 5, 80131 Naples, Italy; (C.M.D.C.); (S.N.); (M.O.)
| | - Rosetta Esposito
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Ludovico Docimo
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
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17
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Hadzialjevic B, Omerzel M, Trotovsek B, Cemazar M, Jesenko T, Sersa G, Djokic M. Electrochemotherapy combined with immunotherapy - a promising potential in the treatment of cancer. Front Immunol 2024; 14:1336866. [PMID: 38292489 PMCID: PMC10825954 DOI: 10.3389/fimmu.2023.1336866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024] Open
Abstract
Electrochemotherapy is a novel, locoregional therapy that is used to treat cutaneous and deep-seated tumors. The electric pulses used in electrochemotherapy increase the permeability of the cell membranes of the target lesion and thus enhance the delivery of low-permeant cytotoxic drugs to the cells, leading to their death. It has also been postulated that electrochemotherapy acts as an in situ vaccination by inducing immunogenic cell death. This in turn leads to an enhanced systemic antitumor response, which could be further exploited by immunotherapy. However, only a few clinical studies have investigated the role of combined treatment in patients with melanoma, breast cancer, hepatocellular carcinoma, and cutaneous squamous cell carcinoma. In this review, we therefore aim to review the published preclinical evidence on combined treatment and to review clinical studies that have investigated the combined role of electrochemotherapy and immunotherapy.
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Affiliation(s)
- Benjamin Hadzialjevic
- Department of Abdominal Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Masa Omerzel
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Blaz Trotovsek
- Department of Abdominal Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Tanja Jesenko
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Mihajlo Djokic
- Department of Abdominal Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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18
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Kadunc BV, Brunner CHM. Treatment of keloids with intralesional bleomycin and electroporation. Int J Dermatol 2024; 63:e20-e22. [PMID: 37830302 DOI: 10.1111/ijd.16875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 08/08/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Bogdana V Kadunc
- Dermatologia, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | - Carlos H M Brunner
- Instituto de Ciências da Saúde - Medicina Veterinária, Universidade Paulista, São Paulo, Brazil
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19
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Baeza-Hernández G, Cañueto J. Intralesional Treatments for Invasive Cutaneous Squamous Cell Carcinoma. Cancers (Basel) 2023; 16:158. [PMID: 38201585 PMCID: PMC10778043 DOI: 10.3390/cancers16010158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most frequent cancer in humans and has the potential to progress locally, metastasize, and cause death in a subset of patients. cSCC is especially common in the elderly, and it will probably represent a major health concern in the near future. Surgery is the standard treatment for cSCC, but intralesional therapies can sometimes be considered for certain patients and under certain circumstances. The choice of intralesional treatment depends on the patient's characteristics and the clinician's previous experience and expertise. Here we are reviewing intralesional treatments for cSCC and keratoacanthoma (KA). We have started with some classic drugs, such as methotrexate and 5-fluorouracil, bleomycin, interferon, and cryosurgery, but also comment on electrochemotherapy. Finally, we have focused on novel therapies, some of which are under development, and future perspectives, including intralesional immunotherapy and oncolytic viruses.
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Affiliation(s)
- Gloria Baeza-Hernández
- Department of Dermatology, Complejo Asistencial Universitario de Salamanca, Paseo San Vicente 58-182, 37007 Salamanca, Spain;
| | - Javier Cañueto
- Department of Dermatology, Complejo Asistencial Universitario de Salamanca, Paseo San Vicente 58-182, 37007 Salamanca, Spain;
- Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Centro de Investigación del Cáncer (CIC)-CSIC, Laboratory 20, 37008 Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca, Paseo San Vicente 58-182, Hospital Virgen de la Vega, 10ª Planta, 37007 Salamanca, Spain
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20
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Andrade DLLS, Pintarelli GB, Rosa JV, Paro IB, Pagano PJT, Silva JCN, Suzuki DOH. Musa acuminata as electroporation model. Bioelectrochemistry 2023; 154:108549. [PMID: 37639773 DOI: 10.1016/j.bioelechem.2023.108549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023]
Abstract
Electrochemotherapy (ECT) and Irreversible electroporation (IRE) are cancer treatments based on electric field distribution in tissues. Solanum tuberosum (potato tissue) phantom is known to mimic changes in the electrical conductivity that occur in animal tissues during electroporation (EP). Electric field distribution is assessed through enzymatic staining. However, the 24-h wait for this assessment could slow agile response scenarios. We developed and validated the Musa acuminata (cavendish banana) conductivity model, which quickly evaluates EP by tissue staining. We investigated the frequency response of the tissue using impedance spectroscopy analysis, conductivity changes, and enzymatic staining. We optimized three usual EP models: adapted Gompertz, smoothed Heaviside, and the sigmoid or logistic function. We found dielectric parameters in banana tissue similar to those in potato (electrical conductivity of 0.035 S/m and relative permittivity of 4.1×104). The coefficients of determination R2 were 99.94% (Gompertz), 99.85% (Heaviside), and 99.58% (sigmoid). The sigmoid and Heaviside functions described the calibration and validation electric currents with 95% confidence. We observed the electroporated areas in bananas 3h30m after EP. Staining was significant after 450 V/cm. The conductivity model of Musa acuminata suits treatment planning, hardware development, and training scenarios. Banana phantom supports the 3Rs practice and is a reliable alternative for potato in EP studies.
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Affiliation(s)
- Daniella L L S Andrade
- Institute of Biomedical Engineering, Department of Electrical and Electronics Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Guilherme B Pintarelli
- Department of Control and Automation Engineering, Federal University of Santa Catarina, Blumenau, SC, Brazil
| | - Juliana V Rosa
- Institute of Biomedical Engineering, Department of Electrical and Electronics Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Isabela B Paro
- Institute of Biomedical Engineering, Department of Electrical and Electronics Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Pedro J T Pagano
- Institute of Biomedical Engineering, Department of Electrical and Electronics Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Julia C N Silva
- Institute of Biomedical Engineering, Department of Electrical and Electronics Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Daniela O H Suzuki
- Institute of Biomedical Engineering, Department of Electrical and Electronics Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil
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21
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Signori E. Electroporation as a cutting edge technique shaping the future of food processing: Comment on: "Advances in pulsed electric stimuli as a physical method for treating liquid foods" by Farzan Zare, Negareh Ghasemi, Nidhi Bansal, Hamid Hosano. Phys Life Rev 2023; 47:3-5. [PMID: 37651759 DOI: 10.1016/j.plrev.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023]
Affiliation(s)
- E Signori
- CNR Institute of Translational Pharmacology, Via del Fosso del Cavaliere 100, 00133 Roma, Italy.
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22
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Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, van Akkooi A, Bataille V, Bastholt L, Dreno B, Dummer R, Fargnoli MC, Forsea AM, Harwood CA, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NW, Lallas A, Leiter U, Malvehy J, Del Marmol V, Moreno-Ramirez D, Pellacani G, Peris K, Saiag P, Tagliaferri L, Trakatelli M, Ioannides D, Vieira R, Zalaudek I, Arenberger P, Eggermont AMM, Röcken M, Grob JJ, Lorigan P. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma: Part 2. Treatment-Update 2023. Eur J Cancer 2023; 193:113252. [PMID: 37708630 DOI: 10.1016/j.ejca.2023.113252] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 09/16/2023]
Abstract
In order to update recommendations on treatment, supportive care, education, and follow-up of patients with invasive cutaneous squamous cell carcinoma (cSCC), a multidisciplinary panel of experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS), the European Academy of Dermatology and Venereology (EADV), and the European Organisation of Research and Treatment of Cancer (EORTC) was formed. Recommendations were based on an evidence-based literature review, guidelines, and expert consensus. Treatment recommendations are presented for common primary cSCC (low risk, high risk), locally advanced cSCC, regional metastatic cSCC (operable or inoperable), and distant metastatic cSCC. For common primary cSCC, the first-line treatment is surgical excision with postoperative margin assessment or micrographically controlled surgery. Achieving clear surgical margins is the most important treatment consideration for patients with cSCCs amenable to surgery. Regarding adjuvant radiotherapy for patients with high-risk localised cSCC with clear surgical margins, current evidence has not shown significant benefit for those with at least one high-risk factor. Radiotherapy should be considered as the primary treatment for non-surgical candidates/tumours. For cSCC with cytologically or histologically confirmed regional nodal metastasis, lymph node dissection is recommended. For patients with metastatic or locally advanced cSCC who are not candidates for curative surgery or radiotherapy, anti-PD-1 agents are the first-line systemic treatment, with cemiplimab being the first approved systemic agent for advanced cSCC by the Food and Drugs Administration/European Medicines Agency. Second-line systemic treatments for advanced cSCC, include epidermal growth factor receptor inhibitors (cetuximab) combined with chemotherapy or radiotherapy. Multidisciplinary board decisions are mandatory for all patients with advanced cSCC, considering the risks of toxicity, the age and frailty of patients, and co-morbidities, including immunosuppression. Patients should be engaged in informed, shared decision-making on management and be provided with the best supportive care to improve symptom management and quality of life. The frequency of follow-up visits and investigations for subsequent new cSCC depends on underlying risk characteristics.
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Affiliation(s)
- Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Clio Dessinioti
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Celeste Lebbe
- Université Paris Cite, Dermato-Oncology AP-HP Hôpital Saint Louis, Cancer Institute APHP. Nord-Université Paris Cite, INSERM U976, Paris, France
| | - Alexander van Akkooi
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Melanoma Institute Australia, Sydney, New South Wales, Australia
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Reinhard Dummer
- Skin Cancer Centre at University Hospital, Zurich, Switzerland
| | - Maria Concetta Fargnoli
- Dermatology Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana Maria Forsea
- Carol Davila University of Medicine and Pharmacy Bucharest, Department of Oncologic Dermatology, Elias University Hospital Bucharest, Bucharest, Romania
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Wj Kelleners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Dermatology, Maastricht University Medical Centre+, Maastricht University, Maastricht, the Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBER de enfermedades raras, Instituto Carlos III, Barcelona, Spain
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - David Moreno-Ramirez
- Department of Medical and Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré hospital, APHP, and EA 4340 'Biomarkers in Cancerology and Hemato-oncology', UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy
| | - Myrto Trakatelli
- Department of Dermatology, Papageorgiou Hospital, Aristotle University Department of Medicine, Thessaloniki, Greece
| | | | - Ricardo Vieira
- Department of Dermatology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alexander M M Eggermont
- University Medical Center Utrecht and Princess Máxima Center, Utrecht, the Netherlands; Comprehensive Cancer Center Munich, Technical University Munich and Ludwig Maximilian University, Munich, Germany
| | - Martin Röcken
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | | | - Paul Lorigan
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, Christie NHS Foundation Trust, Manchester, UK
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23
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Qian K, Zhong Z. Research frontiers of electroporation-based applications in cancer treatment: a bibliometric analysis. BIOMED ENG-BIOMED TE 2023; 68:445-456. [PMID: 37185096 DOI: 10.1515/bmt-2023-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Electroporation, the breakdown of the biomembrane induced by external electric fields, has increasingly become a research hotspot for its promising related methods in various kinds of cancers. CONTENT In this article, we utilized CiteSpace 6.1.R2 to perform a bibliometric analysis on the research foundation and frontier of electroporation-based applications in cancer therapy. A total of 3,966 bibliographic records were retrieved from the Web of Science Core Collection for the bibliometric analysis. Sersa G. and Mir L. M. are the most indispensable researchers in this field, and the University of Ljubljana of Slovenia is a prominent institution. By analyzing references and keywords, we found that, with a lower recurrence rate, fewer severe adverse events, and a higher success rate, irreversible electroporation, gene electrotransfer, and electrochemotherapy are the three main research directions that may influence the future treatment protocol of cancers. SUMMARY This article visualized relevant data to synthesize scientific research on electroporation-based cancer therapy, providing helpful suggestions for further investigations on electroporation. OUTLOOK Although electroporation-based technologies have been proven as promising tools for cancer treatment, its radical mechanism is still opaque and their commercialization and universalization need further efforts from peers.
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Affiliation(s)
- Kun Qian
- Department of High-voltage and Insulation, School of Electrical Engineering, Chongqing University, Chongqing, China
| | - Zilong Zhong
- Research Institute of Foreign Languages, Beijing Foreign Studies University, Beijing, China
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24
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Peris K, Fargnoli MC, Kaufmann R, Arenberger P, Bastholt L, Seguin NB, Bataille V, Brochez L, Del Marmol V, Dummer R, Forsea AM, Gaudy-Marqueste C, Harwood CA, Hauschild A, Höller C, Kandolf L, Kellerners-Smeets NWJ, Lallas A, Leiter U, Malvehy J, Marinović B, Mijuskovic Z, Moreno-Ramirez D, Nagore E, Nathan P, Stratigos AJ, Stockfleth E, Tagliaferri L, Trakatelli M, Vieira R, Zalaudek I, Garbe C. European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma-update 2023. Eur J Cancer 2023; 192:113254. [PMID: 37604067 DOI: 10.1016/j.ejca.2023.113254] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 08/23/2023]
Abstract
Basal cell carcinoma (BCC) is the most common malignant tumour in white populations. Multidisciplinary experts from European Association of Dermato-Oncology (EADO), European Dermatology Forum, European Society for Radiotherapy and Oncology (ESTRO), Union Européenne des Médecins Spécialistes, and the European Academy of Dermatology and Venereology developed updated recommendations on diagnosis and treatment of BCC. BCCs were categorised into 'easy-to-treat' (common) and 'difficult-to-treat' according to the new EADO clinical classification. Diagnosis is based on clinico-dermatoscopic features, although histopathological confirmation is mandatory in equivocal lesions. The first-line treatment of BCC is complete surgery. Micrographically controlled surgery shall be offered in high-risk and recurrent BCC, and BCC located on critical anatomical sites. Topical therapies and destructive approaches can be considered in patients with low-risk superficial BCC. Photodynamic therapy is an effective treatment for superficial and low-risk nodular BCCs. Management of 'difficult-to-treat' BCCs should be discussed by a multidisciplinary tumour board. Hedgehog inhibitors (HHIs), vismodegib or sonidegib, should be offered to patients with locally advanced and metastatic BCC. Immunotherapy with anti-PD1 antibodies (cemiplimab) is a second-line treatment in patients with a progression of disease, contraindication, or intolerance to HHI therapy. Radiotherapy represents a valid alternative in patients who are not candidates for or decline surgery, especially elderly patients. Electrochemotherapy may be offered when surgery or radiotherapy is contraindicated. In Gorlin patients, regular skin examinations are required to diagnose and treat BCCs at an early stage. Long-term follow-up is recommended in patients with high-risk BCC, multiple BCCs, and Gorlin syndrome.
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Affiliation(s)
- Ketty Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | | | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London SE1 7EH, UK
| | - Lieve Brochez
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University Zurich, Switzerland
| | - Ana-Marie Forsea
- Department of Oncologic Dermatology, Elias University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | | | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Lidija Kandolf
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Nicole W J Kellerners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands; Department of Dermatology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
| | - Josep Malvehy
- Department of Dermatology, Hospital Clínic de Barcelona (Melanoma Unit), University of Barcelona, IDIBAPS, Barcelona & CIBERER, Barcelona, Spain
| | - Branka Marinović
- Department of Dermatology and Venereology, University Hospital Center Zagreb, Croatia
| | - Zeljko Mijuskovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - David Moreno-Ramirez
- Dermatology. Medicine School, University of Seville, University Hospital Virgen Macarena, Seville-Spain
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Eggert Stockfleth
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Rome, Italy
| | - Myrto Trakatelli
- Second Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ricardo Vieira
- Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Dermatology Clinic, University of Trieste, Trieste, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard-Karls University, Tuebingen, Germany
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25
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Bonadies A, Iorio A, Silipo V, Cota C, Govoni FA, Battista M, Pallara T, Migliano E. Bleomycin Electrochemotherapy of Dermal Cylindroma as an Alternative Treatment in a Rare Adnexal Neoplasm: A Case Report and Literature Review. Biomedicines 2023; 11:2667. [PMID: 37893041 PMCID: PMC10604352 DOI: 10.3390/biomedicines11102667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Brooke-Spiegler syndrome is a rare autosomal dominant disorder characterized by the continuous development of multiple benign skin appendage tumors. It is treated usually by repeated standard surgery. Here, we present a case study where electrochemotherapy (ECT) with bleomycin was used as an effective alternative approach in treating advanced dermal cylindromatosis of the head and neck in a patient with Brooke-Spiegler syndrome. PATIENTS AND METHODS A 45-year-old woman presented with multiple recurrent dermal cylindroma lesions on her scalp. Previous treatment consisted of several surgical excisions that resulted in psychological deterioration due to the formation of numerous scars and extensive alopecic areas. ECT was offered to provide tumor removal and disease control and to improve the patient's quality of life. RESULTS The treatment was well tolerated, and a significant reduction in neoplastic tissue was achieved. Importantly, scalp skin condition significantly improved, regaining a fair follicular density on the margins. CONCLUSION This report suggests the feasibility of bleomycin ECT as a less invasive alternative option for controlling multiple scalp cylindroma lesions with cosmetically acceptable results, and improving quality of life.
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Affiliation(s)
- Antonio Bonadies
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute—IRCCS, 00144 Rome, Italy; (T.P.); (E.M.)
| | - Alessandra Iorio
- Department of Oncologic and Preventative Dermatology, San Gallicano Dermatological Institute—IRCCS, 00144 Rome, Italy; (A.I.); (V.S.)
| | - Vitaliano Silipo
- Department of Oncologic and Preventative Dermatology, San Gallicano Dermatological Institute—IRCCS, 00144 Rome, Italy; (A.I.); (V.S.)
| | - Carlo Cota
- Dermatopathological Laboratory, San Gallicano Dermatological Institute—IRCCS, 00144 Rome, Italy;
| | - Flavio Andrea Govoni
- Department of Maxillofacial Surgery, ACO San Camillo, Forlanini, 00152 Rome, Italy;
| | - Michela Battista
- Scientific & Medical Department, IGEA S.p.A, 41012 Carpi, Italy;
| | - Tiziano Pallara
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute—IRCCS, 00144 Rome, Italy; (T.P.); (E.M.)
| | - Emilia Migliano
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute—IRCCS, 00144 Rome, Italy; (T.P.); (E.M.)
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26
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Sauer N, Szlasa W, Szewczyk A, Novickij V, Saczko J, Baczyńska D, Daczewska M, Kulbacka J. Effects of Nanosecond Pulsed Electric Field on Immune Checkpoint Receptors in Melanoma Cells. Pharmaceuticals (Basel) 2023; 16:1362. [PMID: 37895833 PMCID: PMC10610193 DOI: 10.3390/ph16101362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/11/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
Checkpoint molecules such as PD-1, LAG-3, and TIM-3 are currently under extensive investigation for their roles in the attenuation of the immune response in cancer. Various methods have been applied to overcome the challenges in this field. This study investigated the effects of nanosecond pulsed electric field (nsPEF) treatment on the expression of immune checkpoint molecules in A375 and C32 melanoma cells. The researchers found that the nsPEF treatment was able to enhance membrane permeabilization and morphological changes in the cell membrane without being cytotoxic. We found that the effects of nsPEFs on melanoma included (1) the transport of vesicles from the inside to the outside of the cells, (2) cell contraction, and (3) the migration of lipids from inside the cells to their peripheries. The treatment increased the expression of PD-1 checkpoint receptors. Furthermore, we also observed potential co-localization or clustering of MHC class II and PD-1 molecules on the cell surface and the secretion of cytokines such as TNF-α and IL-6. These findings suggest that nsPEF treatment could be a viable approach to enhance the delivery of therapeutic agents to cancer cells and to modulate the tumor microenvironment to promote an antitumor immune response. Further studies are needed to explore the mechanisms underlying these effects and their impacts on the antitumor immune response, and to investigate the potential of nsPEF treatment in combination with immune checkpoint inhibitors to improve clinical outcomes for cancer patients.
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Affiliation(s)
- Natalia Sauer
- Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Wojciech Szlasa
- Faculty of Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Anna Szewczyk
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, 51-618 Wroclaw, Poland; (A.S.); (D.B.)
- Department of Animal Developmental Biology, Faculty of Biological Sciences, University of Wroclaw, Sienkiewicza 21, 50-335 Wroclaw, Poland;
| | - Vitalij Novickij
- Institute of High Magnetic Fields, Vilnius Gediminas Technical University, 08217 Vilnius, Lithuania;
- Department of Immunology, State Research Institute Centre for Innovative Medicine, Santariškių 5, 08410 Vilnius, Lithuania
| | - Jolanta Saczko
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, 51-618 Wroclaw, Poland; (A.S.); (D.B.)
| | - Dagmara Baczyńska
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, 51-618 Wroclaw, Poland; (A.S.); (D.B.)
| | - Małgorzata Daczewska
- Department of Animal Developmental Biology, Faculty of Biological Sciences, University of Wroclaw, Sienkiewicza 21, 50-335 Wroclaw, Poland;
| | - Julita Kulbacka
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, 51-618 Wroclaw, Poland; (A.S.); (D.B.)
- Department of Immunology, State Research Institute Centre for Innovative Medicine, Santariškių 5, 08410 Vilnius, Lithuania
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Sieni E, Dettin M, Zamuner A, Conconi MT, Bazzolo B, Balducci C, Di Barba P, Forzan M, Lamberti P, Mognaschi ME. Finite Element Evaluation of the Electric Field Distribution in a Non-Homogeneous Environment. Bioengineering (Basel) 2023; 10:1062. [PMID: 37760163 PMCID: PMC10525744 DOI: 10.3390/bioengineering10091062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Finite element analysis is used in this study to investigate the effect of media inhomogeneity on the electric field distribution in a sample composed of cells and their extracellular matrix. The sample is supposed to be subjected to very high pulsed electric field. Numerically computed electric field distribution and transmembrane potential at the cell membrane in electroporation conditions are considered in order to study cell behavior at different degrees of inhomogeneity. The different inhomogeneity grade is locally obtained using a representative model of fixed volume with cell-cell distance varying in the range of 1-283 um. The conductivity of the extracellular medium was varied between plain collagen and a gel-like myxoid matrix through combinations of the two, i.e., collagen and myxoid. An increase in the transmembrane potential was shown in the case of higher aggregate. The results obtained in this study show the effect of the presence of the cell aggregates and collagen on the transmembrane potential. In particular, by increasing the cell aggregation in the two cases, the transmembrane potential increased. Finally, the simulation results were compared to experimental data obtained by culturing HCC1954 cells in a hyaluronic acid-based scaffold. The experimental validation confirmed the behavior of the transmembrane potential in presence of the collagen: an increase in electroporation at a lower electric field intensity was found for the cells cultured in the scaffolds where there is the formation of collagen areas.
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Affiliation(s)
- Elisabetta Sieni
- Department of Theoretical and Applied Sciences, University of Insubria, Via Dunant 3, 21100 Varese, Italy
- Italian Interuniversity Center ICEMB (Interaction between Electromagnetic Fields and Biosystems), DIET University of Genoa, 16145 Genoa, Italy; (P.L.); (M.E.M.)
| | - Monica Dettin
- Department of Industrial Engineering, University of Padua, Via Marzolo 9, 35131 Padua, Italy; (M.D.); (C.B.); (M.F.)
| | - Annj Zamuner
- Department of Civil Environmental and Architectural Engineering, University of Padua, Via Marzolo 9, 35131 Padua, Italy;
| | - Maria Teresa Conconi
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padua, Italy; (M.T.C.); (B.B.)
| | - Bianca Bazzolo
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padua, Italy; (M.T.C.); (B.B.)
| | - Cristian Balducci
- Department of Industrial Engineering, University of Padua, Via Marzolo 9, 35131 Padua, Italy; (M.D.); (C.B.); (M.F.)
| | - Paolo Di Barba
- Department of Electrical, Computer and Biomedical Engineering, Pavia University, Via Ferrata 5, 21100 Pavia, Italy;
| | - Michele Forzan
- Department of Industrial Engineering, University of Padua, Via Marzolo 9, 35131 Padua, Italy; (M.D.); (C.B.); (M.F.)
| | - Patrizia Lamberti
- Italian Interuniversity Center ICEMB (Interaction between Electromagnetic Fields and Biosystems), DIET University of Genoa, 16145 Genoa, Italy; (P.L.); (M.E.M.)
- Department of Information and Electrical Engineering and Applied Mathematics, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Italy
| | - Maria Evelina Mognaschi
- Italian Interuniversity Center ICEMB (Interaction between Electromagnetic Fields and Biosystems), DIET University of Genoa, 16145 Genoa, Italy; (P.L.); (M.E.M.)
- Department of Electrical, Computer and Biomedical Engineering, Pavia University, Via Ferrata 5, 21100 Pavia, Italy;
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28
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Vissing M, Pervan M, Pløen J, Schnefeldt M, Rafaelsen SR, Jensen LH, Rody A, Gehl J. Calcium electroporation in cutaneous metastases - A non-randomised phase II multicentre clinical trial. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106925. [PMID: 37268521 DOI: 10.1016/j.ejso.2023.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Cutaneous metastases can cause distressing symptoms and be challenging to treat. Local therapies are essential in management. Calcium electroporation uses calcium and electrical pulses to selectively kill cancer cells. This multicentre study aimed to define response in cutaneous metastases across different cancer types. METHODS Patients with tumours ≤3 cm of any histology were included (stable or progressing on current therapy ≥2 months), at three centres. Tumours were treated with 220 mM calcium chloride injection and manual application of eight 0.1 ms pulses with 1 kV/cm and 1Hz with a handheld electrode, in local or general anaesthesia. Clinical response was evaluated after 1, 2, 3, 4, 5, 6, and 12 months. Primary endpoint was response at two months. The overall response rate (ORR) was partial- and complete responses of treated tumours. MR-imaging and qualitative interviews were performed in respective subsets. RESULTS Nineteen patients with disseminated cancer (breast n = 4, lung n = 5, pancreatic n = 1, colorectal n = 2, gastric n = 1, and endometrial cancer n = 1) were enrolled, and 58 metastases were treated (50 once, 8 retreated). The ORR was 36% (95% CI 22-53) after two months. Best ORR was 51% (CR 42%; PR 9%). Previous irradiation improved outcomes (p = 0.0004). Adverse events were minimal. Median pain score was reduced after two months (p = 0.017). Treatment may relieve symptoms according to qualitative interviews. MRI showed restriction in treated tissue. CONCLUSION The majority of tumours were treated only once with calcium electroporation, achieving an ORR of 36% after two months and best ORR of 51%. Efficacy, symptom-relief and safety support calcium electroporation as a palliative treatment option for cutaneous metastases.
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Affiliation(s)
- Mille Vissing
- Center for Experimental Drug and Gene Electrotransfer (C∗EDGE), Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Næstved, Ringstedgade 61, 4700, Næstved, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Mascha Pervan
- Department of Gynaecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Germany Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - John Pløen
- Department of Oncology, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
| | - Mazen Schnefeldt
- Department of Radiology, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
| | - Søren Rafael Rafaelsen
- Department of Radiology, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
| | - Lars Henrik Jensen
- Department of Oncology, University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
| | - Achim Rody
- Department of Gynaecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Germany Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Julie Gehl
- Center for Experimental Drug and Gene Electrotransfer (C∗EDGE), Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Næstved, Ringstedgade 61, 4700, Næstved, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
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29
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Martin CH, Martin RCG. Optimal Dosing and Patient Selection for Electrochemotherapy in Solid Abdominal Organ and Bone Tumors. Bioengineering (Basel) 2023; 10:975. [PMID: 37627860 PMCID: PMC10451240 DOI: 10.3390/bioengineering10080975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
The primary aim of this study was to analyze studies that use electrochemotherapy (ECT) in "deep-seated" tumors in solid organs (liver, kidney, bone metastasis, pancreas, and abdomen) and understand the similarities between patient selection, oncologic selection, and use of new procedures and technology across the organ systems to assess response rates. A literature search was conducted using the term "Electrochemotherapy" in the title field using publications from 2017 to 2023. After factoring in inclusion and exclusion criteria, 29 studies were analyzed and graded based on quality in full. The authors determined key patient and oncologic selection characteristics and ECT technology employed across organ systems that yielded overall responses, complete responses, and partial responses of the treated tumor. It was determined that key selection factors included: the ability to be administered bleomycin, life expectancy greater than three months, unrespectability of the lesion being treated, and a later stage, more advanced cancer. Regarding oncologic selection, all patient cohorts had received chemotherapy or surgery previously but had disease recurrence, making ECT the only option for further treatment. Lastly, in terms of the use of technology, the authors found that studies with better response rates used the ClinporatorTM and updated procedural guidelines by SOP. Thus, by considering patient, oncologic, and technology selection, ECT can be further improved in treating lesions in solid organs.
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Affiliation(s)
| | - Robert C. G. Martin
- Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40202, USA
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30
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McMillan AT, McElroy L, O'Toole L, Matteucci P, Totty JP. Electrochemotherapy vs radiotherapy in the treatment of primary cutaneous malignancies or cutaneous metastases from primary solid organ malignancies: A systematic review and narrative synthesis. PLoS One 2023; 18:e0288251. [PMID: 37440502 PMCID: PMC10343145 DOI: 10.1371/journal.pone.0288251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Electrochemotherapy has gained international traction and commendation in national guidelines as an effective tool in the management of cutaneous malignancies not amenable to surgical resection. Despite this, no level 5 evidence exists comparing it to radiotherapy in the treatment of cutaneous malignancies. This systematic review aimed to examine the literature directly and indirectly comparing electrochemotherapy and radiotherapy in the treatment of primary cutaneous malignancies or cutaneous metastases from primary solid organ malignancies. MATERIALS & METHODS The protocol for this review was registered on the PROSPERO International Prospective Register of Systematic Reviews with the protocol ID CRD42021285415. Searches of MEDLINE, Embase, CINAHL, CENTRAL and ClinicalTrials.gov databases were undertaken from database inception to 28 December 2021. Studies in humans comparing treatment with electrochemotherapy to radiotherapy and reporting tumour response with a minimum four week follow-up were eligible. Risk of bias was assessed using the ROBINS-I tool. Results are provided as a narrative synthesis. RESULTS Two case series with a total of 92 patients were identified as relevant to this study. Both case series examined patients with cutaneous squamous cell carcinoma. One case series examined elderly patients with predominantly head/neck lesions. The other examined younger patients with predominantly limb lesions who had cutaneous squamous cell carcinoma directly attributable to a rare skin condition. CONCLUSION There is little literature presenting comparative data for electrochemotherapy and radiotherapy in the treatment of primary cutaneous malignancies or cutaneous metastases. Included studies were marred by serious risk of bias particularly due to confounding. The inherent bias and heterogeneity of the included studies precluded synthesis of a consolidated comparison of clinical outcomes between the two therapies. Further research is required in this domain in the form of clinical trials and observational studies to inform guidelines for electrochemotherapy treatment.
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Affiliation(s)
- Angus Torry McMillan
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Cottingham, United Kingdom
| | - Luke McElroy
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, United Kingdom
| | - Lorcan O'Toole
- Department of Oncology, Hull University Teaching Hospitals NHS Trust, Cottingham, United Kingdom
| | - Paolo Matteucci
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Cottingham, United Kingdom
| | - Joshua Philip Totty
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Cottingham, United Kingdom
- Centre for Clinical Sciences, Hull York Medical School, Hull, United Kingdom
- University of Hull, Cottingham Road, Hull, United Kingdom
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31
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Guedert R, Brasil Pintarelli G, Mena Barreto Silva FR, Ota Hisayasu Suzuki D. Effects of pulse repetition rate in static electrochemotherapy models. Bioelectrochemistry 2023; 153:108499. [PMID: 37413821 DOI: 10.1016/j.bioelechem.2023.108499] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
Electroporation alters cell membrane structure and tissue electrical properties by short and intense pulsed electric fields (PEF). Static mathematical models are often used to explain the change in electrical properties of tissues caused by electroporation. Electric pulse repetition rate may play an important role, as tissue dielectric dispersion, electroporation dynamics, and Joule heating may affect the electrical properties. In this work, we investigate the effects on the magnitude of the electric current when the repetition rate of the standard electrochemotherapy protocol is increased. Liver, oral mucosa, and muscle tissues were studied. Ex vivo animal experiments show that the magnitude of the electric current increases when the repetition rate is changed from 1 Hz to 5 kHz (10.8% for liver, 5.8% for oral mucosa, and 4.7% for muscle). Although a correction factor could reduce the error to less than 1%, dynamic models seem to be necessary to analyze different protocol signatures. Authors should be aware that static models and experimental results can only be compared if they use exactly the same PEF signature. The repetition rate is a key information to consider in the pretreatment computer study because the current at 1 Hz PEF differs from a 5 kHz PEF.
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Affiliation(s)
- Raul Guedert
- Institute of Biomedical Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
| | - Guilherme Brasil Pintarelli
- Department of Control and Automation Engineering, Federal University of Santa Catarina, Blumenau, SC, Brazil.
| | - Fátima Regina Mena Barreto Silva
- Hormone and Signals Transduction Laboratory, Núcleo de Bioeletricidade Celular (NUBIOCEL), Departamento de Bioquímica, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
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32
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Campana LG, Daud A, Lancellotti F, Arroyo JP, Davalos RV, Di Prata C, Gehl J. Pulsed Electric Fields in Oncology: A Snapshot of Current Clinical Practices and Research Directions from the 4th World Congress of Electroporation. Cancers (Basel) 2023; 15:3340. [PMID: 37444450 PMCID: PMC10340685 DOI: 10.3390/cancers15133340] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/29/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
The 4th World Congress of Electroporation (Copenhagen, 9-13 October 2022) provided a unique opportunity to convene leading experts in pulsed electric fields (PEF). PEF-based therapies harness electric fields to produce therapeutically useful effects on cancers and represent a valuable option for a variety of patients. As such, irreversible electroporation (IRE), gene electrotransfer (GET), electrochemotherapy (ECT), calcium electroporation (Ca-EP), and tumour-treating fields (TTF) are on the rise. Still, their full therapeutic potential remains underappreciated, and the field faces fragmentation, as shown by parallel maturation and differences in the stages of development and regulatory approval worldwide. This narrative review provides a glimpse of PEF-based techniques, including key mechanisms, clinical indications, and advances in therapy; finally, it offers insights into current research directions. By highlighting a common ground, the authors aim to break silos, strengthen cross-functional collaboration, and pave the way to novel possibilities for intervention. Intriguingly, beyond their peculiar mechanism of action, PEF-based therapies share technical interconnections and multifaceted biological effects (e.g., vascular, immunological) worth exploiting in combinatorial strategies.
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Affiliation(s)
- Luca G. Campana
- Department of Surgery, Manchester University NHS Foundation Trust, Oxford Rd., Manchester M13 9WL, UK;
| | - Adil Daud
- Department of Medicine, University of California, 550 16 Street, San Francisco, CA 94158, USA;
| | - Francesco Lancellotti
- Department of Surgery, Manchester University NHS Foundation Trust, Oxford Rd., Manchester M13 9WL, UK;
| | - Julio P. Arroyo
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA; (J.P.A.); (R.V.D.)
| | - Rafael V. Davalos
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA; (J.P.A.); (R.V.D.)
- Institute for Critical Technology and Applied Sciences, Virginia Tech, Blacksburg, VA 24061, USA
| | - Claudia Di Prata
- Department of Surgery, San Martino Hospital, 32100 Belluno, Italy;
| | - Julie Gehl
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, 4000 Roskilde, Denmark;
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165 Copenhagen, Denmark
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Lyons P, Polini D, Russell-Ryan K, Clover AJP. High-Frequency Electroporation and Chemotherapy for the Treatment of Cutaneous Malignancies: Evaluation of Early Clinical Response. Cancers (Basel) 2023; 15:3212. [PMID: 37370822 DOI: 10.3390/cancers15123212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/28/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
High-frequency electroporation (HF-EP) with chemotherapy is a novel therapy proposed for both curative and palliative treatment of cutaneous malignancies. The use of high-frequency biphasic pulses is thought to reduce the painful muscle contractions associated with traditional electrochemotherapy (ECT), allowing treatment administration under local anaesthesia. This proof-of-concept study investigated the efficacy and tolerability of HF-EP protocols on a variety of cutaneous malignancies. A total of 97 lesions of five different histological subtypes were treated across 25 patients. At 12 weeks post-treatment, a 91.3% overall lesion response rate was observed (complete response: 79%; partial response: 12.3%), with excellent intraprocedural patient tolerability under local anaesthetic. HF-EP with chemotherapy shows promising results regarding tumour response rates for cutaneous malignancies of varying histological subtypes when compared to traditional ECT protocols. Improved patient tolerability is important, increasing the possibility of treatment delivery under local anaesthesia and potentially broadening the treatment envelope for patients with cutaneous malignancies.
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Affiliation(s)
- Phoebe Lyons
- Department of Plastic Surgery, Cork University Hospital, T12 DC4A Cork, Ireland
| | - Dana Polini
- School of Medicine, University College Cork, T12 YN60 Cork, Ireland
| | | | - A James P Clover
- Department of Plastic Surgery, Cork University Hospital, T12 DC4A Cork, Ireland
- Cancer Research@UCC, University College Cork, T12 YN60 Cork, Ireland
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34
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Di Prata C, Mascherini M, Ross AM, Silvestri B, Kis E, Odili J, Fabrizio T, Jones RP, Kunte C, Orlando A, Clover J, Kumar S, Russano F, Matteucci P, Muir T, Terlizzi FD, Gehl J, Grischke EM. Efficacy of Electrochemotherapy in Breast Cancer Patients of Different Receptor Status: The INSPECT Experience. Cancers (Basel) 2023; 15:3116. [PMID: 37370726 DOI: 10.3390/cancers15123116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Electrochemotherapy has been proven to be an efficient treatment for cutaneous metastases of various cancers. Data on breast cancer (BC) patients with cutaneous metastases were retrieved from the INSPECT database. Patients were divided by their receptor status: HER2+, HR+ (ER/PgR+), and TN (triple negative). Groups were similar for histological subtype and location of the nodules. Most patients were previously treated with surgery/systemic therapy/radiotherapy. We found no differences in the three groups in terms of response ratio (OR per patient 86% HER2+, 80% HR+, 76% TN, p = 0.8664). The only factor positively affecting the complete response rate in all groups was small tumor size (<3 cm, p = 0.0105, p = 0.0001, p = 0.0266, respectively). Local progression-free survival was positively impacted by the achievement of complete response in HER2+ (p = 0.0297) and HR+ (p = 0.0094), while overall survival was affected by time to local progression in all groups (p = 0.0065 in HER2+, p < 0.0001 in HR+, p = 0.0363 in TN). ECT treatment is equally effective among groups, despite different receptor status. Response and local tumor control seem to be better in multiple small lesions than in big armor-like lesions, suggesting that treating smaller, even multiple, lesions at the time of occurrence is more effective than treating bigger long-lasting armor-like cutaneous lesions.
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Affiliation(s)
- Claudia Di Prata
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, 35128 Padua, Italy
| | - Matteo Mascherini
- Department of Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | | | - Barbara Silvestri
- Oncology and Haematology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima-Mirano, 30035 Venice, Italy
| | - Erika Kis
- Department of Dermatology and Allergology, University of Szeged, H-6720 Szeged, Hungary
| | - Joy Odili
- Department of Plastic Surgery, St. Georges University Hospitals NHS Trust, London SW17 0QT, UK
| | - Tommaso Fabrizio
- Unit of Plastic Surgery, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 85028 Rionero in Vulture, Italy
| | - Rowan Pritchard Jones
- Department of Plastic Surgery, Edge Hill University, Ormskirk L39 4QP, UK
- Department of Plastic Surgery, University of Liverpool, Liverpool L7 8TX, UK
| | - Christian Kunte
- Abteilung für Dermatochirurgie und Dermatologie, Artemed Fachklinik München, 80336 Munich, Germany
| | - Antonio Orlando
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
| | - James Clover
- Department of Plastic Surgery, Cork University Hospital, T12 DC4A Cork, Ireland
- Cancer Reseach@UCC, University College Cork, T12 YN60 Cork, Ireland
| | - Siva Kumar
- Department of Plastic Surgery, Queen Victoria Hospital National Health Service (NHS) Foundation Trust, East Grinstead RH19 3DZ, UK
| | - Francesco Russano
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Paolo Matteucci
- Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, UK
| | - Tobian Muir
- Department of Plastic Surgery, James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | | | - Julie Gehl
- Center for Experimental Drug and Gene Electrotransfer (C*EDGE), Department of Clinical Oncology and Palliative Care, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Eva-Maria Grischke
- Department of Gynecology, University Hospital of Tübingen, 72076 Tübingen, Germany
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35
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Vivod G, Bosnjak M, Kovacevic N, Sersa G, Merlo S, Cemazar M. Safety and Feasibility of Vulvar Cancer Treatment with Electrochemotherapy. Cancers (Basel) 2023; 15:3079. [PMID: 37370690 DOI: 10.3390/cancers15123079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Electrochemotherapy is a local ablative therapy used for the treatment of various superficial and deep-seated tumors. Electrochemotherapy involves the application of electric pulses locally to tumors to destabilize cell membranes and facilitate the entry of cytotoxic drugs, thereby enhancing their cytotoxicity locally. The aim of our study is to investigate the safety and feasibility of electrochemotherapy in patients with vulvar cancer recurrence used for nonpalliative purposes. Ten patients with single local vulvar cancer recurrence were treated with intravenous bleomycin, followed by a local application of electric pulses (electrochemotherapy) to the tumor. Adverse events were determined using the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The feasibility of treating vulvar cancer with electrochemotherapy was determined by an appropriate selection of electrodes based on the size and location of the tumor with safety margins included. Electrochemotherapy was feasible in all patients. No electrochemotherapy-related or other serious adverse events occurred. Our data suggest that electrochemotherapy is a feasible and safe technique for the treatment of vulvar cancer recurrence for nonpalliative purposes. Based on our results, electrochemotherapy might be a viable therapeutic tool for patients who would otherwise undergo surgery involving a mutilation of the external genitalia.
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Affiliation(s)
- Gregor Vivod
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Masa Bosnjak
- Department of Experimental Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Nina Kovacevic
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Health Care Angela Boskin, 4270 Jesenice, Slovenia
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Sebastjan Merlo
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Health Sciences, University of Primorska, 6000 Izola, Slovenia
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36
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Muir T, Bertino G, Groselj A, Ratnam L, Kis E, Odili J, McCafferty I, Wohlgemuth WA, Cemazar M, Krt A, Bosnjak M, Zanasi A, Battista M, de Terlizzi F, Campana LG, Sersa G. Bleomycin electrosclerotherapy (BEST) for the treatment of vascular malformations. An International Network for Sharing Practices on Electrochemotherapy (InspECT) study group report. Radiol Oncol 2023; 57:141-149. [PMID: 37341196 DOI: 10.2478/raon-2023-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/03/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Biomedical applications of electroporation are expanding out of the field of oncology into vaccination, treatment of arrhythmias and now in the treatment of vascular malformations. Bleomycin is a widely used sclerosing agent in the treatment of various vascular malformations. The application of electric pulses in addition to bleomycin enhances the effectiveness of the drug, as demonstrated by electrochemotherapy, which utilizes bleomycin in the treatment of tumors. The same principle is used in bleomycin electrosclerotherapy (BEST). The approach seems to be effective in the treatment of low-flow (venous and lymphatic) and, potentially, even high-flow (arteriovenous) malformations. Although there are only a few published reports to date, the surgical community is interested, and an increasing number of centers are applying BEST in the treatment of vascular malformations. Within the International Network for Sharing Practices on Electrochemotherapy (InspECT) consortium, a dedicated working group has been constituted to develop standard operating procedures for BEST and foster clinical trials. CONCLUSIONS By treatment standardization and successful completion of clinical trials demonstrating the effectiveness and safety of the approach, higher quality data and better clinical outcomes may be achieved.
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Affiliation(s)
- Tobian Muir
- Department of Reconstructive Plastic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Giulia Bertino
- Department of Otolaryngology Head Neck Surgery, University of Pavia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo Foundation, Pavia, Italy
| | - Ales Groselj
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Lakshmi Ratnam
- Department of Interventional Radiology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Erika Kis
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Joy Odili
- Department of Plastic Surgery, St. Georges University Hospitals NHS Trust, London, United Kingdom
| | - Ian McCafferty
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Walter A Wohlgemuth
- Universitätsklinik und Poliklinik für Radiologie, Universitätsmedizin Halle, Halle, Germany
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Primorska, Slovenia
| | - Aljosa Krt
- Department of Otorhinolaryngology, Izola General Hospital, Izola, Slovenia
| | - Masa Bosnjak
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | | | | | - Luca G Campana
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
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Tellado M, De Robertis M, Montagna D, Giovannini D, Salgado S, Michinski S, Signori E, Maglietti F. Electrochemotherapy Plus IL-2+IL-12 Gene Electrotransfer in Spontaneous Inoperable Stage III-IV Canine Oral Malignant Melanoma. Vaccines (Basel) 2023; 11:1033. [PMID: 37376422 DOI: 10.3390/vaccines11061033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Electrochemotherapy (ECT) is a standard of care in veterinary and human oncology. The treatment induces a well-characterized local immune response which is not able to induce a systemic response. In this retrospective cohort study, we evaluated the addition of gene electrotransfer (GET) of canine IL-2 peritumorally and IL-12 intramuscularly to enhance the immune response. Thirty canine patients with inoperable oral malignant melanoma were included. Ten patients received ECT+GET as the treatment group, while twenty patients received ECT as the control group. Intravenous bleomycin for the ECT was used in both groups. All patients had compromised lymph nodes which were surgically removed. Plasma levels of interleukins, local response rate, overall survival, and progression-free survival were evaluated. The results show that IL-2 and IL-12 expression peaked around days 7-14 after transfection. Both groups showed similar local response rates and overall survival times. However, progression-free survival resulted significantly better in the ECT+GET group, which is a better indicator than overall survival, as it is not influenced by the criterion used for performing euthanasia. We can conclude that the combination of ECT+GET using IL-2 and IL-12 improves treatment outcomes by slowing down tumoral progression in stage III-IV inoperable canine oral malignant melanoma.
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Affiliation(s)
- Matías Tellado
- VetOncologia, Veterinary Oncology Clinic, Buenos Aires 1408, Argentina
| | - Mariangela De Robertis
- Department of Biosciences, Biotechnology and Environment, University of Bari 'A. Moro', 70125 Bari, Italy
| | - Daniela Montagna
- Instituto de Medicina Experimental (IMEX-CONICET), Academia Nacional de Medicina, Buenos Aires 1425, Argentina
| | - Daniela Giovannini
- ENEA SSPT-TECS-TEB, Casaccia Research Center, Division of Health Protection Technology (TECS), Agenzia Nazionale per le Nuove Tecnologie, l'Energia e lo Sviluppo Economico Sostenibile (ENEA), 00123 Rome, Italy
- Laboratory of Molecular Pathology and Experimental Oncology, Institute of Translational Pharmacology, CNR, Rome 0133, Italy
| | - Sergio Salgado
- CREOVet, Veterinary Oncology Clinic, Lima 04, Peru
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Peruana Cayetano Heredia, Lima 31, Peru
| | - Sebastián Michinski
- Instituto de Física Interdsiciplinaria y Aplicada (INFINA), Facultad de Cs Exactas y Naturales, UBA-CONICET, Buenos Aires 1428, Argentina
| | - Emanuela Signori
- Laboratory of Molecular Pathology and Experimental Oncology, Institute of Translational Pharmacology, CNR, Rome 0133, Italy
| | - Felipe Maglietti
- Instituto Universitario de Ciencias de la Salud, Fundación Barceló-CONICET, Buenos Aires 1117, Argentina
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Lampreht Tratar U, Milevoj N, Cemazar M, Znidar K, Ursic Valentinuzzi K, Brozic A, Tomsic K, Sersa G, Tozon N. Treatment of spontaneous canine mast cell tumors by electrochemotherapy combined with IL-12 gene electrotransfer: Comparison of intratumoral and peritumoral application of IL-12. Int Immunopharmacol 2023; 120:110274. [PMID: 37216797 DOI: 10.1016/j.intimp.2023.110274] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/24/2023] [Accepted: 04/30/2023] [Indexed: 05/24/2023]
Abstract
The combined treatment of electrochemotherapy (ECT) and interleukin-12 (IL-12) gene electrotransfer (GET) has already been used in clinical studies in dogs to treat various histological types of spontaneous tumors. The results of these studies show that the treatment is safe and effective. However, in these clinical studies, the routes of administration of IL-12 GET were either intratumoral (i.t.) or peritumoral (peri.t.). Therefore, the objective of this clinical trial was to compare the two IL-12 GET routes of administration in combination with ECT and their contribution to the enhanced ECT response. Seventy-seven dogs with spontaneous mast cell tumors (MCTs) were divided into three groups: one treated with a combination of ECT + GET peri. t. (29 dogs), the second with the combination of ECT + GET i.t. (30 dogs), and the third with ECT alone (18 dogs). In addition, immunohistochemical studies of tumor samples before treatment and flow cytometry of peripheral blood mononuclear cells (PBMCs) before and after treatment were performed to determine any immunological aspects of the treatment. The results showed that local tumor control was significantly better in the ECT + GET i.t. group (p < 0.050) than in the ECT + GET peri.t. or ECT groups. In addition, disease-free interval (DFI) and progression-free survival (PFS) were significantly longer in the ECT + GET i.t. group than in the other two groups (p < 0.050). The data on local tumor response, DFI, and PFS were consistent with immunological tests, as we detected an increased percentage of antitumor immune cells in the blood after treatment in the ECT + GET i.t. group, which also indicated the induction of a systemic immune response. In addition, we did not observe any unwanted severe or long-lasting side effects. Finally, due to the more pronounced local response after ECT + GET i.t., we suggest that treatment response assessment should be performed at least two months after treatment, which meets the iRECIST criteria.
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Affiliation(s)
- Ursa Lampreht Tratar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia; Veterinary Faculty, University of Ljubljana, Gerbiceva 60, 1000 Ljubljana, Slovenia
| | - Nina Milevoj
- Veterinary Faculty, University of Ljubljana, Gerbiceva 60, 1000 Ljubljana, Slovenia
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia; Faculty of Health Sciences, University of Primorska, Polje 42, 6310 Izola, Slovenia.
| | - Katarina Znidar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia
| | - Katja Ursic Valentinuzzi
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia; Biotechnical Faculty, University of Ljubljana, Jamnikarjeva ulica 101, 1000 Ljubljana, Slovenia
| | - Andreja Brozic
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia
| | - Katerina Tomsic
- Veterinary Faculty, University of Ljubljana, Gerbiceva 60, 1000 Ljubljana, Slovenia
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia; Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, 1000 Ljubljana, Slovenia
| | - Natasa Tozon
- Veterinary Faculty, University of Ljubljana, Gerbiceva 60, 1000 Ljubljana, Slovenia.
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Milicevic S, Cemazar M, Ivancic AK, Gasljevic G, Bosnjak M, Sersa G, Peric B. Electrochemotherapy of Melanoma Cutaneous Metastases in Organ Transplant Recipients: A Systematic Review of Preclinical and Clinical Studies. Int J Mol Sci 2023; 24:ijms24098335. [PMID: 37176042 PMCID: PMC10179383 DOI: 10.3390/ijms24098335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Cutaneous melanoma is a highly aggressive form of skin cancer. The development of immune checkpoint inhibitors (ICIs) has revolutionized the management of advanced melanoma, led to durable responses, and improved overall survival. However, the success of ICIs in melanoma treatment is influenced by the tumor microenvironment (TME) which plays a critical role in regulating the immune response to the tumor. Understanding the mechanisms underlying this interaction is crucial to optimizing the efficiency of ICIs. Electrochemotherapy (ECT) has been shown to enhance the efficacy of ICIs in melanoma treatment by inducing tumor cell death and facilitating the release of tumor antigens which can subsequently be recognized and targeted by the immune system. Moreover, ECT has been reported to modulate the TME, leading to increased infiltration of immune cells and a more favorable immunological profile. In this review, we summarize the available knowledge of changes in TME after ECT of melanoma cutaneous metastasis and highlight the differences in tumor-infiltrating immune cells between immunocompetent and immunosuppressed organisms. In addition, we showed that ECT can be an effective and safe procedure for organ transplant recipients. Furthermore, repeated ECT may enhance immune activation and probably induce a bystander effect by trained immunity.
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Affiliation(s)
- Sara Milicevic
- Institute of Oncology Ljubljana, Zaloska Cesta 2, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia
| | - Maja Cemazar
- Institute of Oncology Ljubljana, Zaloska Cesta 2, 1000 Ljubljana, Slovenia
- Faculty of Health Sciences, University of Primorska, Polje 42, 6310 Izola, Slovenia
| | | | - Gorana Gasljevic
- Institute of Oncology Ljubljana, Zaloska Cesta 2, 1000 Ljubljana, Slovenia
| | - Masa Bosnjak
- Institute of Oncology Ljubljana, Zaloska Cesta 2, 1000 Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Askerceva Cesta 7, 1000 Ljubljana, Slovenia
| | - Gregor Sersa
- Institute of Oncology Ljubljana, Zaloska Cesta 2, 1000 Ljubljana, Slovenia
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena Pot 5, 1000 Ljubljana, Slovenia
| | - Barbara Peric
- Institute of Oncology Ljubljana, Zaloska Cesta 2, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia
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40
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Kesar U, Markelc B, Jesenko T, Ursic Valentinuzzi K, Cemazar M, Strojan P, Sersa G. Effects of Electrochemotherapy on Immunologically Important Modifications in Tumor Cells. Vaccines (Basel) 2023; 11:vaccines11050925. [PMID: 37243029 DOI: 10.3390/vaccines11050925] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Electrochemotherapy (ECT) is a clinically acknowledged method that combines the use of anticancer drugs and electrical pulses. Electrochemotherapy with bleomycin (BLM) can induce immunogenic cell death (ICD) in certain settings. However, whether this is ubiquitous over different cancer types and for other clinically relevant chemotherapeutics used with electrochemotherapy is unknown. Here, we evaluated in vitro in the B16-F10, 4T1 and CT26 murine tumor cell lines, the electrochemotherapy triggered changes in the ICD-associated damage-associated molecular patterns (DAMPs): Calreticulin (CRT), ATP, High Mobility Group Box 1 (HMGB1), and four immunologically important cellular markers: MHCI, MHC II, PD-L1 and CD40. The changes in these markers were investigated in time up to 48 h after ECT. We showed that electrochemotherapy with all three tested chemotherapeutics induced ICD-associated DAMPs, but the induced DAMP signature was cell line and chemotherapeutic concentration specific. Similarly, electrochemotherapy with CDDP, OXA or BLM modified the expression of MHC I, MHC II, PD-L1 and CD40. The potential of electrochemotherapy to change their expression was also cell line and chemotherapeutic concentration specific. Our results thus put the electrochemotherapy with clinically relevant chemotherapeutics CDDP, OXA and BLM on the map of ICD inducing therapies.
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Affiliation(s)
- Ursa Kesar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Bostjan Markelc
- Department of Experimental Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Tanja Jesenko
- Department of Experimental Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Katja Ursic Valentinuzzi
- Department of Experimental Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
- Biotechnical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Health Sciences, University of Primorska, 6310 Izola, Slovenia
| | - Primoz Strojan
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Department of Radiation Oncology, Institute of Oncology, 1000 Ljubljana, Slovenia
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia
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Ibrahimi N, Vallet L, Andre FM, Rivaletto M, Novac BM, Mir LM, Pécastaing L. An Overview of Subnanosecond Pulsed Electric Field Biological Effects: Toward Contactless Technologies for Cancer Treatment. Bioelectricity 2023. [DOI: 10.1089/bioe.2022.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Affiliation(s)
- Njomza Ibrahimi
- Laboratoire des Sciences de l'Ingénieur Appliquées à la Mécanique et au Génie Électrique–Fédération IPRA, EA4581, Université de Pau et des Pays de l'Adour/E2S UPPA, Pau, France
| | - Leslie Vallet
- Université Paris-Saclay, CNRS, Gustave Roussy, UMR 9018, Metabolic and Systemic Aspects of Oncogenesis (METSY), Villejuif, France
| | - Franck M. Andre
- Université Paris-Saclay, CNRS, Gustave Roussy, UMR 9018, Metabolic and Systemic Aspects of Oncogenesis (METSY), Villejuif, France
| | - Marc Rivaletto
- Laboratoire des Sciences de l'Ingénieur Appliquées à la Mécanique et au Génie Électrique–Fédération IPRA, EA4581, Université de Pau et des Pays de l'Adour/E2S UPPA, Pau, France
| | - Bucur M. Novac
- Laboratoire des Sciences de l'Ingénieur Appliquées à la Mécanique et au Génie Électrique–Fédération IPRA, EA4581, Université de Pau et des Pays de l'Adour/E2S UPPA, Pau, France
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom
| | - Lluis M. Mir
- Université Paris-Saclay, CNRS, Gustave Roussy, UMR 9018, Metabolic and Systemic Aspects of Oncogenesis (METSY), Villejuif, France
| | - Laurent Pécastaing
- Laboratoire des Sciences de l'Ingénieur Appliquées à la Mécanique et au Génie Électrique–Fédération IPRA, EA4581, Université de Pau et des Pays de l'Adour/E2S UPPA, Pau, France
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42
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de Caro A, Bellard E, Kolosnjaj-Tabi J, Golzio M, Rols MP. Gene Electrotransfer Efficiency in 2D and 3D Cancer Cell Models Using Different Electroporation Protocols: A Comparative Study. Pharmaceutics 2023; 15:pharmaceutics15031004. [PMID: 36986866 PMCID: PMC10053976 DOI: 10.3390/pharmaceutics15031004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
Electroporation, a method relying on a pulsed electric field to induce transient cell membrane permeabilization, can be used as a non-viral method to transfer genes in vitro and in vivo. Such transfer holds great promise for cancer treatment, as it can induce or replace missing or non-functioning genes. Yet, while efficient in vitro, gene-electrotherapy remains challenging in tumors. To assess the differences of gene electrotransfer in respect to applied pulses in multi-dimensional (2D, 3D) cellular organizations, we herein compared pulsed electric field protocols applicable to electrochemotherapy and gene electrotherapy and different "High Voltage-Low Voltage" pulses. Our results show that all protocols can result in efficient permeabilization of 2D- and 3D-grown cells. However, their efficiency for gene delivery varies. The gene-electrotherapy protocol is the most efficient in cell suspensions, with a transfection rate of about 50%. Conversely, despite homogenous permeabilization of the entire 3D structure, none of the tested protocols allowed gene delivery beyond the rims of multicellular spheroids. Taken together, our findings highlight the importance of electric field intensity and the occurrence of cell permeabilization, and underline the significance of pulses' duration, impacting plasmids' electrophoretic drag. The latter is sterically hindered in 3D structures and prevents the delivery of genes into spheroids' core.
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Affiliation(s)
- Alexia de Caro
- Institut de Pharmacologie et de Biologie Structurale du CNRS UMR 5089, 205, Route de Narbonne, 31077 Toulouse CEDEX, France
| | - Elisabeth Bellard
- Institut de Pharmacologie et de Biologie Structurale du CNRS UMR 5089, 205, Route de Narbonne, 31077 Toulouse CEDEX, France
| | - Jelena Kolosnjaj-Tabi
- Institut de Pharmacologie et de Biologie Structurale du CNRS UMR 5089, 205, Route de Narbonne, 31077 Toulouse CEDEX, France
| | - Muriel Golzio
- Institut de Pharmacologie et de Biologie Structurale du CNRS UMR 5089, 205, Route de Narbonne, 31077 Toulouse CEDEX, France
| | - Marie-Pierre Rols
- Institut de Pharmacologie et de Biologie Structurale du CNRS UMR 5089, 205, Route de Narbonne, 31077 Toulouse CEDEX, France
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Barca I, Ferragina F, Kallaverja E, Arrotta A, Cristofaro MG. Electrochemotherapy as an Effective Alternative in the Treatment of Local Advanced Oral Squamous Cell Carcinoma: A Retrospective Analysis of Treated Cases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5170. [PMID: 36982078 PMCID: PMC10049161 DOI: 10.3390/ijerph20065170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 06/18/2023]
Abstract
Advanced oral squamous cell carcinomas represent a major challenge for maxillofacial surgeons, oncologists and radiation therapists. They also account for a large share of healthcare costs. They respond little and/or poorly to conventional therapies (surgery, radiotherapy and chemotherapy). Electrochemotherapy is a new method used as a palliative treatment in patients with advanced cancer of the neck/head region who are not eligible for standard therapies. It combines the use of cytotoxic drugs with the physical principle of electroporation; it effectively controls the tumour locally and preserves organ function. To date, ECT has been little used for oral mucosal tumours, as this is difficult to access for electrodes. We report six cases of advanced oral squamous cell carcinoma treated with electrochemotherapy. This study aims to assess the debulking effect of cancer via ECT in patients with advanced oral squamous cell carcinoma. It also aims to assess the safety and tolerability of this treatment.
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Affiliation(s)
- Ida Barca
- Unit of Maxillofacial Surgery, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
| | - Francesco Ferragina
- Unit of Maxillofacial Surgery, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
| | - Elvis Kallaverja
- Unit of Maxillofacial Surgery, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
| | - Antonella Arrotta
- Department of Medical and Surgical Sciences, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
| | - Maria Giulia Cristofaro
- Unit of Maxillofacial Surgery, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Viale Europa, 88100 Catanzaro, Italy
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Spiliotis AE, Holländer S, Rudzitis-Auth J, Wagenpfeil G, Eisele R, Nika S, Mallis Kyriakides O, Laschke MW, Menger MD, Glanemann M, Gäbelein G. Evaluation of Electrochemotherapy with Bleomycin in the Treatment of Colorectal Hepatic Metastases in a Rat Model. Cancers (Basel) 2023; 15:cancers15051598. [PMID: 36900388 PMCID: PMC10000671 DOI: 10.3390/cancers15051598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/15/2023] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The available ablative procedures for the treatment of hepatic cancer have contraindications due to the heat-sink effect and the risk of thermal injuries. Electrochemotherapy (ECT) as a nonthermal approach may be utilized for the treatment of tumors adjacent to high-risk regions. We evaluated the effectiveness of ECT in a rat model. METHODS WAG/Rij rats were randomized to four groups and underwent ECT, reversible electroporation (rEP), or intravenous injection of bleomycin (BLM) eight days after subcapsular hepatic tumor implantation. The fourth group served as Sham. Tumor volume and oxygenation were measured before and five days after the treatment using ultrasound and photoacoustic imaging; thereafter, liver and tumor tissue were additionally analysed by histology and immunohistochemistry. RESULTS The ECT group showed a stronger reduction in tumor oxygenation compared to the rEP and BLM groups; moreover, ECT-treated tumors exhibited the lowest levels of hemoglobin concentration compared to the other groups. Histological analyses further revealed a significantly increased tumor necrosis of >85% and a reduced tumor vascularization in the ECT group compared to the rEP, BLM, and Sham groups. CONCLUSION ECT is an effective approach for the treatment of hepatic tumors with necrosis rates >85% five days following treatment.
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Affiliation(s)
- Antonios E. Spiliotis
- Department of Surgery, Campus Charité Mitte, Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Correspondence: or ; Tel.: +49-0304-5065-2625
| | - Sebastian Holländer
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, 66421 Homburg, Germany
| | - Jeannette Rudzitis-Auth
- Institute for Clinical and Experimental Surgery, Saarland University, 66421 Homburg, Germany
| | - Gudrun Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, 66421 Homburg, Germany
| | - Robert Eisele
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, 66421 Homburg, Germany
| | - Spyridon Nika
- Department of Urology and Pediatric Urology, Saarland University Medical Center, 66421 Homburg, Germany
| | - Orestis Mallis Kyriakides
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, 66421 Homburg, Germany
| | - Matthias W. Laschke
- Institute for Clinical and Experimental Surgery, Saarland University, 66421 Homburg, Germany
| | - Michael D. Menger
- Institute for Clinical and Experimental Surgery, Saarland University, 66421 Homburg, Germany
| | - Matthias Glanemann
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, 66421 Homburg, Germany
| | - Gereon Gäbelein
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, 66421 Homburg, Germany
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Vivod G, Jesenko T, Gasljevic G, Kovacevic N, Bosnjak M, Sersa G, Merlo S, Cemazar M. Treatment of vulvar cancer recurrences with electrochemotherapy - a detailed analysis of possible causes for unsuccessful treatment. Radiol Oncol 2023; 57:121-126. [PMID: 36795008 PMCID: PMC10039473 DOI: 10.2478/raon-2023-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Electrochemotherapy has good local effectiveness in the treatment of vulvar cancer. Most studies have reported the safety and effectiveness of electrochemotherapy for palliative treatment of gynecological cancers and mostly vulvar squamous cell carcinoma. Some tumors, however, fail to respond to electrochemotherapy. The biological features/determinants for the nonresponsiveness are not determined yet. PATIENT AND METHODS A recurrence of vulvar squamous cell carcinoma was treated by electrochemotherapy using intravenous administration of bleomycin. The treatment was performed by hexagonal electrodes according to standard operating procedures. We analyzed the factors that could determine nonresponsiveness to electrochemotherapy. RESULTS Based on the presented case of nonresponsive vulvar recurrence to electrochemotherapy, we hypothesize that the vasculature of the tumors prior to treatment may predict the response to electrochemotherapy. The histological analysis showed minimal presence of blood vessels in the tumor. Thus, low perfusion may reduce drug delivery and lead to a lower response rate because of the minor antitumor effectiveness of vascular disruption. In this case, no immune response in the tumor was elicited by electrochemotherapy. CONCLUSIONS In this case, of nonresponsive vulvar recurrence treated by electrochemotherapy, we analyzed possible factors that could predict treatment failure. Based on histological analysis, low vascularization of the tumor was observed, which hampered drug delivery and distribution and resulted in no vascular disrupting action of electro-chemotherapy. All these factors could contribute to ineffective treatment with electrochemotherapy.
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Affiliation(s)
- Gregor Vivod
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Medical Faculty Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Tanja Jesenko
- Medical Faculty Ljubljana, University of Ljubljana, Ljubljana, Slovenia
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Gorana Gasljevic
- Department Pathology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Nina Kovacevic
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Medical Faculty Ljubljana, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Health Care Angela Boškin, Jesenice, Slovenia
| | - Masa Bosnjak
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Sebastjan Merlo
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Medical Faculty Ljubljana, University of Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
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de Castro Cunha RM, Lavalle GE, Nunes FC, de Oliveira AR, de Lima Santos R, de Araújo RB. Canine squamous cell carcinoma: Electrochemotherapy association with surgery and correlation with overall survival. Vet Comp Oncol 2023; 21:240-254. [PMID: 36745052 DOI: 10.1111/vco.12882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/07/2023]
Abstract
Squamous cell carcinoma (SCC) is an important malignancy in dogs, due to its incidence and clinical presentation, which can be of locally aggressive single or multiple lesions with a metastatic potential. The objective of this investigation was to evaluate SCC response to treatment, anatomopathological and immunohistochemical characteristics, disease-free interval and overall survival time. 54 dogs with histopathologically diagnosed SCC were included in this study. Their mean age was 9.16 years with a range of 1-14 years. Of the 54 animals in the study, 34 (65.4%) had white skin and white fur coats. There was a significant correlation between fur coat colour and the development of tumours in areas of sun exposure (p = .001). Animals with tumours in areas of the body exposed to the sun had longer overall survival time than animals with tumours in areas not associated with sun exposure (p = .001). Surgery combined with electrochemotherapy (ECT) yielded a survival rate 32% higher than using a surgical approach alone (HR = 0.32, p = .038, IC = 0.11-0.94). ECT, with or without surgery, had an objective response rate of 90.9%. Local lymph node and/or distant site metastasis at diagnosis, or at some point during follow-up, occurred in 34.6% (18/52) of animals. Animals with tumours in sun exposed locations had more aggressive histopathological characteristics but had longer overall survival time. This is probably due to individualised therapeutic treatment with both surgery and ECT.
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Affiliation(s)
- Rúbia Monteiro de Castro Cunha
- Department of Veterinary Clinic and Surgery, Veterinary School, Veterinary Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Gleidice Eunice Lavalle
- Department of Veterinary Clinic and Surgery, Veterinary School, Veterinary Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Ayisa Rodrigues de Oliveira
- Department of Veterinary Pathology, Veterinary School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Renato de Lima Santos
- Department of Veterinary Pathology, Veterinary School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Roberto Baracat de Araújo
- Department of Veterinary Clinic and Surgery, Veterinary School, Veterinary Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Pfefferle V, Leiter U, Grünke T, Kofler K, Häfner HM, Kofler L. Electrochemotherapy under analgosedation - Case report of a patient with Kaposi's sarcoma. J Eur Acad Dermatol Venereol 2023; 37:e209-e211. [PMID: 35972805 DOI: 10.1111/jdv.18518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/05/2022] [Indexed: 01/19/2023]
Affiliation(s)
| | | | | | | | | | - Lukas Kofler
- Universitätshautklinik Tübingen, Tübingen, Germany
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48
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Lindelauf KHK, Baragona M, Baumann M, Maessen RTH, Ritter A. Pulse Parameters and Thresholds for (ir)Reversible Electroporation on Hepatocellular Carcinoma Cells in Vitro. Technol Cancer Res Treat 2023; 22:15330338221136694. [PMID: 36600679 PMCID: PMC9829997 DOI: 10.1177/15330338221136694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Hepatocellular carcinoma is a leading cause of cancer-related death in many parts of the world. Traditional treatment options are not always effective. During the promising minimally invasive electroporation-based therapies, biological cell membranes are exposed to an external, sufficiently high, pulsed electric field which creates so-called nanopores into the lipid bilayer of the cell membrane. These pores can either be permanent (irreversible electroporation (IRE)), leading to apoptosis, or repairable (reversible electroporation (RE)), with continued cell function. In tumor therapy, RE is used to increase the diffusion of a chemotherapeutic drug during electrochemotherapy. For both IRE and RE, the success of the treatment is dependent on application of the appropriate electric field. Therefore, this study aims to define the pulse parameters and thresholds for IRE and RE on hepatocellular carcinoma (HepG2) cells in-vitro.In a custom-made in-vitro setup, HepG2 cell viability (0, 5, 10, and 15 min), and the peak temperature were measured after electroporation with the different IRE and RE pulsing protocols, to determine the most successful settings for IRE and RE. A CAM/PI flow cytometric assay was performed to confirm cell permeabilization for the RE pulsing protocols with the highest cell viability.The results indicated that an IRE pulsing protocol (70 pulses, 100 µs pulse length, and 100 ms interval) with an electric field strength of 4000 V/cm was needed as threshold for almost complete cell death of HepG2 cells. A RE pulsing protocol (8 pulses, 100 µs pulse length, and 1000 ms interval) with an electric field strength of 1000 V/cm was needed as threshold for viable and permeabilized HepG2 cells. The low peak temperatures (max 30.1°C for IRE, max 23.1°C for RE) within this study indicated that the reduction in HepG2 cell viability was caused by the applied electric field and was not a result of Joule heating.
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Affiliation(s)
- K. H. K. Lindelauf
- Department of Diagnostic and Interventional Radiology,
University
Hospital RWTH Aachen, Aachen, Germany,Philips
Research, Eindhoven, the Netherlands,K. H. K. Lindelauf, Department of
Diagnostic and Interventional Radiology, University Hospital RWTH Aachen,
Aachen, Germany.
| | - M. Baragona
- Philips
Research, Eindhoven, the Netherlands
| | - M. Baumann
- Institute of Applied Medical Engineering,
RWTH Aachen
University, Aachen, Germany
| | | | - A. Ritter
- Department of Diagnostic and Interventional Radiology,
University
Hospital RWTH Aachen, Aachen, Germany
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Zhong S, Yao S, Zhao Q, Wang Z, Liu Z, Li L, Wang ZL. Electricity‐Assisted Cancer Therapy: From Traditional Clinic Applications to Emerging Methods Integrated with Nanotechnologies. ADVANCED NANOBIOMED RESEARCH 2022. [DOI: 10.1002/anbr.202200143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Songjing Zhong
- Beijing Institute of Nanoenergy and Nanosystems Chinese Academy of Sciences Beijing 101400 P.R. China
- School of Nanoscience and Technology University of Chinese Academy of Sciences Beijing 101400 P.R. China
| | - Shuncheng Yao
- Beijing Institute of Nanoenergy and Nanosystems Chinese Academy of Sciences Beijing 101400 P.R. China
- School of Nanoscience and Technology University of Chinese Academy of Sciences Beijing 101400 P.R. China
| | - Qinyu Zhao
- Beijing Institute of Nanoenergy and Nanosystems Chinese Academy of Sciences Beijing 101400 P.R. China
- Center on Nanoenergy Research Guangxi University Nanning 530004 P.R. China
| | - Zhuo Wang
- Beijing Institute of Nanoenergy and Nanosystems Chinese Academy of Sciences Beijing 101400 P.R. China
| | - Zhirong Liu
- Beijing Institute of Nanoenergy and Nanosystems Chinese Academy of Sciences Beijing 101400 P.R. China
- School of Nanoscience and Technology University of Chinese Academy of Sciences Beijing 101400 P.R. China
| | - Linlin Li
- Beijing Institute of Nanoenergy and Nanosystems Chinese Academy of Sciences Beijing 101400 P.R. China
- School of Nanoscience and Technology University of Chinese Academy of Sciences Beijing 101400 P.R. China
- Center on Nanoenergy Research Guangxi University Nanning 530004 P.R. China
| | - Zhong Lin Wang
- Beijing Institute of Nanoenergy and Nanosystems Chinese Academy of Sciences Beijing 101400 P.R. China
- Center on Nanoenergy Research Guangxi University Nanning 530004 P.R. China
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Benedik J, Ogorevc B, Brezar SK, Cemazar M, Sersa G, Groselj A. Comparison of general anesthesia and continuous intravenous sedation for electrochemotherapy of head and neck skin lesions. Front Oncol 2022; 12:1011721. [PMID: 36465339 PMCID: PMC9717680 DOI: 10.3389/fonc.2022.1011721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/21/2022] [Indexed: 11/19/2022] Open
Abstract
BackgroundElectrochemotherapy of cutaneous tumor nodules requires local or general anesthesia. For multiple and larger nodules, general anesthesia is recommended by standard operating procedures. The choice of general anesthesia is at the discretion of the treating center. Continuous intravenous sedation is also an option. Our study aimed to elucidate the tolerability, safety and possible advantages of continuous intravenous sedation in comparison to general anesthesia in patients undergoing electrochemotherapy.Patients and methodsIn the prospective study, 27 patients undergoing electrochemotherapy were either under general anesthesia or under continuous intravenous sedation. Evaluated were different endpoints, such as feasibility and safety, duration of anesthesia and compliance with the patients.ResultsTen patients were treated under general anesthesia, and 17 patients were under continuous intravenous sedation. The comparison of the approaches indicated that continuous intravenous sedation required a lower overall dosage of propofol, a shorter duration of anesthesia, a shorter time to reach an Aldrete score >8, and greater satisfaction of the patients with the procedure compared to general anesthesia.ConclusionThe results indicate the feasibility and safety of continuous intravenous sedation for patients undergoing electrochemotherapy of cutaneous tumor nodules. This proved the preferred choice of anesthesia due to its shorter duration and better compliance with the patients compared to general anesthesia.
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Affiliation(s)
- Janez Benedik
- Department of Anesthesiology and Perioperative Intensive Care Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Barbara Ogorevc
- Department of Anesthesiology and Perioperative Intensive Care Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Simona Kranjc Brezar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
- *Correspondence: Ales Groselj, ; Gregor Sersa,
| | - Ales Groselj
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- *Correspondence: Ales Groselj, ; Gregor Sersa,
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