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Vielsmeier V, Schmidt VF, Obereisenbuchner F, Platz Batista da Silva N, Wohlgemuth WA, Puhr-Westerheide D, Seidensticker M, Ricke J, Kühnel T, Bohr C, Wildgruber M, Seebauer CT. Bleomycin Electrosclerotherapy (BEST) for Slow-Flow Malformations of the Upper Aerodigestive Tract. Biomedicines 2025; 13:1055. [PMID: 40426883 PMCID: PMC12109471 DOI: 10.3390/biomedicines13051055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2025] [Revised: 04/23/2025] [Accepted: 04/25/2025] [Indexed: 05/29/2025] Open
Abstract
Background/Objectives: Bleomycin electrosclerotherapy (BEST), which combines intralesional bleomycin administration with electroporation, enhances drug uptake and has shown efficacy in treating vascular malformations resistant to conventional therapies. While BEST is increasingly used in various anatomical sites, its application in the upper aerodigestive tract remains underexplored. This study evaluates the safety and effectiveness of BEST in managing slow-flow vascular malformations of the oral cavity, tongue, larynx, and hypopharynx. Methods: In this retrospective, multicenter study, 20 patients with symptomatic slow-flow vascular malformations of the upper aerodigestive tract were treated with BEST. Clinical and radiological assessments were used to evaluate the treatment response, categorized as "significantly reduced", "reduced", "stable disease", or "lesion growth". Postprocedural complications and functional outcomes were systematically recorded. Results: A total of 29 BEST sessions were performed. Lesions of the tongue (n = 8) and combined oral cavity and tongue (n = 6) showed the highest response rates, with significant symptom reduction in five out of eight and five out of six patients, respectively. Among isolated oral cavity lesions (n = 4), one out of four demonstrated a significant reduction. In contrast, laryngeal and hypopharyngeal lesions (n = 2) had limited response, with one case showing partial reduction and the other remaining stable. Severe complications, including bleeding and dyspnea requiring tracheostomy, limited further treatment in these locations. No systemic adverse events, such as pulmonary toxicity, were observed. Conclusions: BEST is effective for treating vascular malformations of the upper aerodigestive tract, particularly in the tongue and oral cavity, but presents significant risks in laryngeal and hypopharyngeal lesions. A multidisciplinary approach is required to optimize treatment protocols for these challenging locations.
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Affiliation(s)
- Veronika Vielsmeier
- Department of Otorhinolaryngology, Regensburg University Medical Center, 93053 Regensburg, Germany; (V.V.); (T.K.); (C.B.)
| | - Vanessa F. Schmidt
- Department of Radiology, LMU University Hospital, LMU Munich, 81377 München, Germany; (V.F.S.); (F.O.); (D.P.-W.); (M.S.); (J.R.); (M.W.)
| | - Florian Obereisenbuchner
- Department of Radiology, LMU University Hospital, LMU Munich, 81377 München, Germany; (V.F.S.); (F.O.); (D.P.-W.); (M.S.); (J.R.); (M.W.)
| | | | - Walter A. Wohlgemuth
- Department of Radiology and Policlinic of Radiology, University Hospital Halle (Saale), 06120 Halle (Saale), Germany;
| | - Daniel Puhr-Westerheide
- Department of Radiology, LMU University Hospital, LMU Munich, 81377 München, Germany; (V.F.S.); (F.O.); (D.P.-W.); (M.S.); (J.R.); (M.W.)
| | - Max Seidensticker
- Department of Radiology, LMU University Hospital, LMU Munich, 81377 München, Germany; (V.F.S.); (F.O.); (D.P.-W.); (M.S.); (J.R.); (M.W.)
| | - Jens Ricke
- Department of Radiology, LMU University Hospital, LMU Munich, 81377 München, Germany; (V.F.S.); (F.O.); (D.P.-W.); (M.S.); (J.R.); (M.W.)
| | - Thomas Kühnel
- Department of Otorhinolaryngology, Regensburg University Medical Center, 93053 Regensburg, Germany; (V.V.); (T.K.); (C.B.)
| | - Christopher Bohr
- Department of Otorhinolaryngology, Regensburg University Medical Center, 93053 Regensburg, Germany; (V.V.); (T.K.); (C.B.)
| | - Moritz Wildgruber
- Department of Radiology, LMU University Hospital, LMU Munich, 81377 München, Germany; (V.F.S.); (F.O.); (D.P.-W.); (M.S.); (J.R.); (M.W.)
| | - Caroline T. Seebauer
- Department of Otorhinolaryngology, Regensburg University Medical Center, 93053 Regensburg, Germany; (V.V.); (T.K.); (C.B.)
- Department of Otorhinolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, 6000 Lucerne, Switzerland
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2
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Latini L, Bracco S, Cioni S, Leonini S, Cascino F, Gennaro P. Innovative Use of Bleomycin Electrosclerotherapy (BEST) for High-Flow Arteriovenous Malformations in the Head District: Preliminary Results of Two Cases. J Clin Med 2025; 14:2516. [PMID: 40217965 PMCID: PMC11989358 DOI: 10.3390/jcm14072516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2025] [Revised: 03/29/2025] [Accepted: 04/04/2025] [Indexed: 04/14/2025] Open
Abstract
Background: According to the ISSVA 2018 classification, arteriovenous malformations (AVMs) are high-flow vascular malformations, distinct from low-flow lesions. About 60% of extracranial AVMs occur in the head and neck, making their management a focus of maxillofacial surgery. Due to their complexity, precise diagnosis and careful treatment planning are crucial for optimal aesthetics and structural preservation. The standard approach combines embolization with surgical resection, though Bleomycin electrosclerotherapy (BEST) has recently gained recognition. Methods: From July 2023 to December 2024, a total of 16 patients with vascular malformations were treated with bleomycin electrosclerotherapy at the Azienda Ospedaliera Universitaria Senese (AOUS). Among them, two patients were affected by arteriovenous malformations. These two patients underwent this treatment to avoid more invasive and demolitive procedures, considering the anatomical region involved. Both patients had previously been treated at other hospitals, experiencing subsequent lesion recurrence. Preoperative evaluation included angiographic and ultrasound studies. The patients underwent electrosclerotherapy sessions and were closely monitored during follow-up. The uniqueness of this innovative approach lies in the use of fractionated doses of bleomycin for each treatment session, compared to the standard protocols described in the literature. Results: BEST has demonstrated efficacy in the treatment of high-flow AVMs by delivering bleomycin into the interstitial tissue and subsequently applying electroporation so the drug's effects can be precisely localized and amplified. The macroscopically evident results, patient satisfaction, and, most importantly, the objective ultrasound flow data demonstrate the effectiveness of this treatment. Conclusions: Arteriovenous malformations (AVMs) pose treatment challenges due to their variability and lack of standardized guidelines. This study explores electrosclerotherapy with bleomycin in two head and neck AVM cases, using fractionated doses to enhance safety and efficacy. The findings support its potential as a minimally invasive alternative, warranting further research on broader applications.
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Affiliation(s)
- Linda Latini
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy; (L.L.); (F.C.)
| | - Sandra Bracco
- Neuroimaging and Neurointervention Unit, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy; (S.B.); (S.C.); (S.L.)
| | - Samuele Cioni
- Neuroimaging and Neurointervention Unit, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy; (S.B.); (S.C.); (S.L.)
| | - Sara Leonini
- Neuroimaging and Neurointervention Unit, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy; (S.B.); (S.C.); (S.L.)
| | - Flavia Cascino
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy; (L.L.); (F.C.)
| | - Paolo Gennaro
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy; (L.L.); (F.C.)
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3
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Cassanelli G, Paolantonio G, Parapatt GK, Natali GL. Tumor ablation in children. Pediatr Radiol 2025; 55:733-746. [PMID: 39441218 DOI: 10.1007/s00247-024-06059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 09/09/2024] [Accepted: 09/10/2024] [Indexed: 10/25/2024]
Abstract
Tumor ablation represents an increasingly important topic in pediatric interventional radiology. Many ablative techniques are well known and established in the adult population, and the adoption of these techniques in the pediatric field is increasing. Image-guided tumor ablation represents a wide category of interventional radiology procedures that can be applied to both benign and malignant pediatric solid tumors. Tumor ablation, either alone or in combination with locoregional therapy, can have curative, debulking, or palliative effects on a wide variety of histological tumor types.
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Affiliation(s)
- Giulia Cassanelli
- Interventional Radiology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Guglielmo Paolantonio
- Interventional Radiology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - George Koshy Parapatt
- Interventional Radiology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Gian Luigi Natali
- Interventional Radiology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
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4
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Colletti G, Rozell-Shannon L, Nocini R. MEST: Modified electrosclerotherapy to treat AVM (Extracranial Arterio-venous malformations). Better than BEST. J Craniomaxillofac Surg 2025; 53:391-398. [PMID: 39855981 DOI: 10.1016/j.jcms.2025.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 11/26/2024] [Accepted: 01/10/2025] [Indexed: 01/27/2025] Open
Abstract
Arteriovenous Malformations (AVM) can present themselves in an ample clinical spectrum. They worsen over time, creating local complications such as ulceration, destruction, infection, pain, and severe bleeding. Small focal AVMs can effectively be cured by surgery and/or endovascular techniques, whereas larger ones are of difficult management. Accordingly, S3 AVMs (according to SECg staging) are particularly troublesome. Here, endovascular treatment is only episodically curative while surgery leads to significant structural and functional damage. Electrochemotherapy is an established means to manage selected neoplasms. Recently it was successfully used to treat sclerotherapy-resistant or extensive low-flow vascular malformations (electrosclerotherapy, EST). EST was only anectodically tried with AVMs. A conventional EST is unlikely to effectively have an AVM responding. We conceived the Modified EST (MEST) protocol and started a pilot study. Modification of conventional EST was done by administering bleomycin locally, under ultrasound guidance, in the tissues around the nidus. After 8 min, electroporation was started and covered the entire involved area. MEST was adopted in 10 patients with S3 AVMs of the cervicofacial region. Most patients received 2 sessions of MEST. The response was significant, and the patients all had a complete or near-complete reduction in the size of the AVM. Excellent aesthetic results were achieved. On follow-up imaging the AVMs were not detectable. Side effects were minor and easily managed. Results were stable. The results of the present study suggest that MEST may be the treatment of choice in selected AVMs. However, a longer follow-up is needed to further evaluate the risk of recurrence.
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Affiliation(s)
- Giacomo Colletti
- Cranio-Maxillo-Facial Surgery, SMECHIMAI Department, University of Modena and Reggio Emilia, Modena, Italy.
| | | | - Riccardo Nocini
- Department of Otorhinolaryngology, University of Verona, Verona, Italy
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5
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M. P, Thomas SV, PK MR, Menon R. Immediate Surgical Excision Following Embolization of an Extensive Pediatric Facial High Flow AV Malformation. Indian J Plast Surg 2024; 57:S142-S144. [PMID: 39741715 PMCID: PMC11684976 DOI: 10.1055/s-0044-1787987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025] Open
Affiliation(s)
- Prajwal M.
- Department of Plastic Surgery, Aster MIMS Hospital, Calicut, Kerala, India
| | - Sebin V. Thomas
- Department of Plastic Surgery, Aster MIMS Hospital, Calicut, Kerala, India
| | - Mohammed Rafeeque PK
- Division of Neuro Intervention, Department of Clinical Imaging and Interventional Radiology, Aster MIMS Hospital, Calicut, Kerala
| | - Raghuram Menon
- Department of Plastic Surgery, Aster MIMS Hospital, Calicut, Kerala, India
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6
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Muir T, Wohlgemuth WA, Cemazar M, Bertino G, Groselj A, Ratnam LA, McCafferty I, Wildgruber M, Gebauer B, de Terlizzi F, Zanasi A, Sersa G. Current Operating Procedure (COP) for Bleomycin ElectroScleroTherapy (BEST) of low-flow vascular malformations. Radiol Oncol 2024; 58:469-479. [PMID: 39608012 PMCID: PMC11604259 DOI: 10.2478/raon-2024-0061] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 10/17/2024] [Indexed: 11/30/2024] Open
Abstract
BACKGROUND Bleomycin ElectroScleroTherapy (BEST) is a new approach in the treatment of vascular malformations. After bleomycin is administered to the malformation, electric pulses are applied to the target area to enhance the effectiveness of bleomycin. The mode of action is comparable to the effect of electrochemotherapy on tumour vasculature. For the wider and safer use of BEST in the clinical treatment of low-flow vascular malformations, this Current Operating Procedure (COP) is being prepared. It is a proposal for the clinical standardisation of BEST using the Cliniporator® as the electrical pulse generator with its associated electrodes. The electrical parameters considered in this protocol are those validated by the European Standard Operating Procedures for Electrochemotherapy (ESOPE) with the Cliniporator®. CONCLUSIONS General requirements are proposed, and, depending on the type of lesion, local skills and the availability of radiological equipment, two technical approaches of BEST are described based on ultrasound guided intervention or combined ultrasound and fluoroscopic guided intervention.
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Affiliation(s)
- Tobian Muir
- South Tees NHS Foundation Trust, MiddlesbroughTS4 3BW, United Kingdom
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Primorska, Isola, Slovenia
| | - 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 A Ratnam
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
- City St George’s University of London, School of Health & Medical Sciences, London, United Kingdom
| | - Ian McCafferty
- Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, München, Germany
- Interdisziplinäres Zentrum für Gefäßanomalien (IZGA), University Hospital, LMU Munich, München, Germany
| | - Bernhard Gebauer
- Diagnostic and Interventional Radiology, Charité UniversitätsmedizinBerlin, 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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7
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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; 34:6425-6434. [PMID: 38627287 PMCID: PMC11399160 DOI: 10.1007/s00330-024-10723-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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8
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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: 17] [Impact Index Per Article: 8.5] [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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