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Campana LG, Tauceri F, Bártolo J, Calabrese S, Odili J, Carrara G, Farricha V, Piazzalunga D, Bottyán K, Bisarya K, Mascherini M, Clover JA, Sestini S, Bošnjak M, Kis E, Fantini F, Covarelli P, Brizio M, Sayed L, Cabula C, Careri R, Fabrizio T, Eisendle K, MacKenzie Ross A, Schepler H, Borgognoni L, Sersa G, Valpione S. Treatment strategies with electrochemotherapy for limb in-transit melanoma: Real-world outcomes from a European, retrospective, cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024:108740. [PMID: 39448361 DOI: 10.1016/j.ejso.2024.108740] [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: 05/13/2024] [Revised: 09/04/2024] [Accepted: 10/01/2024] [Indexed: 10/26/2024]
Abstract
BACKGROUND This study analysed treatment strategies with electrochemotherapy (ECT) in melanoma with limb in-transit metastases (ITM). METHODS We audited AJCC v.8 stage IIIB-IIID patients treated across 22 centres (2006-2020) within the International Network for Sharing Practices of ECT (InspECT). RESULTS 452 patients were included, 58 % pre-treated (93 % had lower limb ITM, 44 % had ≤10 metastases [median size 1.5 cm]. Treatment strategies included first-line ECT (n = 145, 32 %), ECT with concurrent locoregional/systemic treatment (n = 163, 36 %), and salvage ECT (n = 144, 32 %). The objective response rate was 63 % (complete response [CR], 24 %), increasing to 74 % (CR, 39 %) following retreatment (median two ECT, range 1-8). CR rate in treatment-naïve and pre-treated patients was 50 % vs 32 % (p < 0.001). Bleomycin de-escalation was associated with lower CR (p = 0.004). Small tumour number and size, hexagonal electrode, retreatment, and post-ECT skin ulceration predicted response in multivariable analysis. At a median follow-up of 61 months, local and locoregional recurrence occurred in 55 % and 81 % of patients. Median local progression-free, new lesions-free, and regional recurrence-free survival were 32.9, 6.9, and 7.7 months. Grade-3 toxicity was 15 %. Concurrent treatment and CR correlated with improved regional control and survival. Concomitant checkpoint inhibition did not impact toxicity or survival outcomes. The median overall survival was 5.7 years. CONCLUSIONS Among patients with low-burden limb-only ITM, standard-dose bleomycin ECT results in durable local response. Treatment naivety, low tumour volume, hexagonal electrode application, retreatment, and post-ECT ulceration predict response. CR and concurrent treatment correlate with improved regional control and survival outcomes. Combination with checkpoint inhibitors is safe but lacks conclusive support.
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Affiliation(s)
- Luca G Campana
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, UK; Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy.
| | - Francesca Tauceri
- General and Oncological Surgery Unit, Morgagni-Pierantoni Hospital, Forli, Italy
| | - Joana Bártolo
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Sarah Calabrese
- Department of Plastic Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Joy Odili
- Department of Plastic and Reconstructive Surgery, St Georges University Hospitals NHS Foundation Trust, London, UK
| | - Giulia Carrara
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Victor Farricha
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Dario Piazzalunga
- General and Emergency Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Kriszta Bottyán
- Department of Dermatology and Allergology, University of Szeged, H-6720, Szeged, Hungary
| | - Kamal Bisarya
- Department of Plastic Surgery, Hull Royal Infirmary, Hull, UK
| | - Matteo Mascherini
- Department of Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - James A Clover
- Department of Plastic Surgery, Cork University Hospital, Cork, Ireland
| | - Serena Sestini
- Plastic and Reconstructive Surgery, Melanoma & Skin Cancer Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Maša Bošnjak
- Institute of Oncology Ljubljana, Department of Experimental Oncology, Ljubljana, Slovenia
| | - Erika Kis
- Department of Dermatology and Allergology, University of Szeged, H-6720, Szeged, Hungary
| | - Fabrizio Fantini
- Dermatology Unit, ASST Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Piero Covarelli
- Surgical Oncology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Matteo Brizio
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Italy
| | - Leela Sayed
- Plastic Surgery Unit, Salisbury District Hospital, Salisbury, UK
| | - Carlo Cabula
- Chirurgia Senologica Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Rosanna Careri
- Department of Dermatology and Plastic Surgery, University La Sapienza, Rome, Italy
| | - Tommaso Fabrizio
- Plastic Surgery Unit, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), Rionero in Vulture, Italy
| | - Klaus Eisendle
- Department of Dermatology and Venerology, Central Teaching Hospital Bolzano, Bolzano, Italy
| | | | - Hadrian Schepler
- Department of Dermatology, University Clinic Mainz, Mainz, Germany
| | - Lorenzo Borgognoni
- Plastic and Reconstructive Surgery, Melanoma & Skin Cancer Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Sara Valpione
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Oncological Sciences, The University of Manchester, Manchester, UK; Cancer Research UK National Biomarker Centre, The University of Manchester, Manchester, UK
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