LIVERPOOL - Electrochemotherapy (ECT) effectively treats both primary and metastatic skin tumours, independent of histological origin, and provides an alternative to surgical intervention, according to study results of ECT with palliative and curative intent.
Co-presenting their findings at this year's British Association of Dermatologists 103rd annual meeting were Meghna Shetty, MBBS, and Brogan Kelly Salence, MBChB, both from Guy's and St Thomas' NHS Foundation Trust, London, UK. The researchers remarked that, although it was under-recognised, "ECT may represent a robust and efficacious treatment option particularly for smaller, lower-risk tumours."
"Despite being around for some time, there is not enough awareness around ECT, but it is certainly an alternative for patients who have co-morbidities or who are unsuitable for other interventions," Dr Shetty told Medscape News UK in an interview after the talk.
Just over 40% of palliative care patients shrunk their tumours while symptomatic relief was achieved in over half. Nearly 60% of treatments with curative intent led to complete resolution.
She pointed out that dermatologists might discuss ECT as an option for patients who have concerns about surgery. "Many of our patients are elderly, but also, in our centre we manage rare genetic conditions where patients tend to develop multiple skin cancers and for them surgery is not an option. ECT is certainly an alternative."
ECT: Under-Recognised Therapy
The National Institute for Health and Care Excellence guidelines from 2013 advise use of ECT for the management of primary basal cell carcinoma and squamous cell carcinoma in selected patients, and as a palliative treatment for skin metastases from tumours of non-skin origin and malignant melanoma, Dr Shetty, pointed out, but added that ECT remained an under-recognised therapy.
In their retrospective cohort study, the researchers aimed to evaluate the outcomes and complications of ECT with palliative and curative intent, using ECT with bleomycin. ECT requires electrical impulses to destabilise cell membranes and increase permeability of chemotherapy agents such as cisplatin or bleomycin. Drs Shetty and Salence analysed data in patients who were treated with ECT between June 2016 to December 2022 to assess the tumour subtype, treatment response, and adverse effects.
They drew patient data from their tertiary centre at Guy's and St Thomas' hospital, covering 71 patients and a total of 89 tumours.The mean age for participants was 69 years, 61% were female, and a linear array electrode was most common tool used. Treatment was palliative in 73.2% of patients and curative in 27%, reported Shetty.
For the palliative ECT care, the majority of patients were treated for metastatic melanoma (35%), squamous cell carcinoma metastases (33%), and breast cancer metastases (21%), while most treatment sites were on the lower limbs (31%). For curative care, the majority were for basal cell carcinoma (BCC) (63%) and the most common treatment site was the head and neck.
Palliative and Curative Care
"We found a 42% reduction in tumour size overall, with symptomatic relief in 52% of patients," Dr Shetty said, relaying results in palliative care patients, adding that "the crude 1-year survival in this group was 83%".
The most common complications were pain and ulceration. However, there was one seizure that may or may not have been related to ECT, and one case of pneumothorax in a patient with metastatic breast cancer where the lesion was directly located on the chest, said Dr Shetty.
Dr Salence shared a case study of a 70-year-old palliative care patient with a 12x12-cm melanoma on the left heel and multiple in-transit metastases despite treatment with ipilimumab, T-VEC, pembrolizumab, and isolated limb perfusion.
"The patient underwent ECT and surgical debulking, and by 4 months she had a good clinical response of the local area and the in-transit metastases such that she was now able to walk and reported improved quality of life. She went on to request further ECT for other in-transit metastases that later developed," she said.
Regarding curative ECT outcomes, complete resolution was seen in 58% of patients where it was used for curative intent, reported Dr Salence. Two patients had recurrence and underwent excision, while the most common complications were ectropion, nerve palsy, indented scarring, ulceration, and pain.
Presenting three curative cases, Dr Salence drew on the example of an 87-year-old man with nodular basal cell carcinoma, and adenoid basal cell carcinoma with multiple co-morbidities. "This patient had ECT and at 6 months post treatment there was no evidence of ulceration or erythema and he had complete resolution of his BCC."
ECT was also used in another patient with Gorlin's syndrome for four primary BCCs resulting in complete resolution but leaving minimal indented scarring due to the tumour volume loss, recounted Dr Salence. Finally, she presented a patient who had a recurrent multifocal pleomorphic dermal sarcoma on the scalp. ECT was undertaken and he has had complete resolution with no recurrence at 2 years of follow up.
Co-moderator Adam Bray, MD, consultant dermatologist from University Hospitals Bristol NHS Foundation Trust in Bristol, commented on the study. "ECT is a very useful treatment option for assessing patients, particularly those highlighted in the talk with difficult metastatic disease with widespread lesions and few other options," he said, adding that, "I think it would be nice to use it for patients with more localised disease as an option to conventional surgery when the surgery is complex or difficult, but I don't think it's quite right for most patients."
Drs Shetty, Salence, and Bray have declared no conflicts of interest.