Treatment of vulvar cancer recurrence with electrochemotherapy: a case-control study
DOI:
https://doi.org/10.2340/1651-226X.2024.33241Keywords:
Vulvar cancer, recurrence, effectiveness, electrochemotherapy, bleomycin, wide excisionAbstract
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.
Downloads
References
Lai J, Elleray R, Nordin A, et al. Vulval cancer incidence, mortality and survival in England: age-related trends. BJOG Int J Obstet Gynaecol. 2014 May;121(6):728–38.
https://doi.org/10.1111/1471-0528.12459 DOI: https://doi.org/10.1111/1471-0528.12459
Holleczek B, Sehouli J, Barinoff J. Vulvar cancer in Germany: increase in incidence and change in tumour biological characteristics from 1974 to 2013. Acta Oncol. 2018 Mar 4;57(3):324–30.
https://doi.org/10.1080/0284186X.2017.1360513 DOI: https://doi.org/10.1080/0284186X.2017.1360513
Tan A, Bieber AK, Stein JA, et al. Diagnosis and management of vulvar cancer: a review. J Am Acad Dermatol. 2019 Dec;81(6):1387–96.
https://doi.org/10.1016/j.jaad.2019.07.055 DOI: https://doi.org/10.1016/j.jaad.2019.07.055
Pedrão PG, Guimarães YM, Godoy LR, et al. Management of early-stage vulvar cancer. Cancers. 2022 Aug 29;14(17):4184.
https://doi.org/10.3390/cancers14174184 DOI: https://doi.org/10.3390/cancers14174184
Zach D, Åvall-Lundqvist E, Falconer H, et al. Patterns of recurrence and survival in vulvar cancer: a nationwide population-based study. Gynecol Oncol. 2021 Jun;161(3):748–54.
https://doi.org/10.1016/j.ygyno.2021.03.013 DOI: https://doi.org/10.1016/j.ygyno.2021.03.013
Giannini A, D’Oria O, Chiofalo B, et al. The giant steps in surgical downsizing toward a personalized treatment of vulvar cancer. J Obstet Gynaecol Res. 2022 Mar;48(3):533–40.
https://doi.org/10.1111/jog.15103 DOI: https://doi.org/10.1111/jog.15103
Campana LG, Miklavčič D, Bertino G, et al. Electrochemotherapy of superficial tumors – current status: basic principles, operating procedures, shared indications, and emerging applications. Semin Oncol. 2019 Apr;46(2):173–91.
https://doi.org/10.1053/j.seminoncol.2019.04.002 DOI: https://doi.org/10.1053/j.seminoncol.2019.04.002
Clover AJP, de Terlizzi F, Bertino G, et al. Electrochemotherapy in the treatment of cutane-ous malignancy: outcomes and subgroup analysis from the cumulative re-sults from the pan-European International Network for Sharing Practice in Electrochemotherapy database for 2482 lesions in 987 patients (2008–2019). Eur J Cancer. 2020 Oct;138:30–40.
https://doi.org/10.1016/j.ejca.2020.06.020 DOI: https://doi.org/10.1016/j.ejca.2020.06.020
Djokic M, Cemazar M, Bosnjak M, et al. A Prospective Phase II Study evaluating intraopera-tive electrochemotherapy of hepatocellular carcinoma. Cancers. 2020 Dec 15;12(12):E3778.
https://doi.org/10.3390/cancers12123778 DOI: https://doi.org/10.3390/cancers12123778
Merlo S, Vivod G, Bebar S, et al. Literature review and our experience with bleomycin-based electrochemotherapy for cutaneous vulvar metastases from endo-metrial cancer. Technol Cancer Res Treat. 2021 Dec;20:15330338211010134.
https://doi.org/10.1177/15330338211010134 DOI: https://doi.org/10.1177/15330338211010134
Granata V, Fusco R, D’Alessio V, et al. Percutanous electrochemotherapy (ECT) in primary and secondary liver malignancies: a systematic review. Diagn Basel Switz. 2023 Jan 5;13(2):209.
https://doi.org/10.3390/diagnostics13020209 DOI: https://doi.org/10.3390/diagnostics13020209
Milicevic S, Cemazar M, Ivancic AK, et al. Electrochemotherapy of melanoma cutaneous metastases in organ transplant recipients: a systematic review of preclini-cal and clinical studies. Int J Mol Sci. 2023 May 6;24(9):8335.
https://doi.org/10.3390/ijms24098335 DOI: https://doi.org/10.3390/ijms24098335
Djokic M, Dezman R, Cemazar M, et al. Percutaneous image guided electrochemotherapy of hepatocellular carcinoma: technological advancement. Radiol Oncol. 2020 Jun 20;54(3):347–52.
https://doi.org/10.2478/raon-2020-0038 DOI: https://doi.org/10.2478/raon-2020-0038
Trotovsek B, Hadzialjevic B, Cemazar M, et al. Laparoscopic electrochemotherapy for the treatment of hepatocellular carcinoma: technological advancement. Front Oncol. 2022;12:996269.
https://doi.org/10.3389/fonc.2022.996269 DOI: https://doi.org/10.3389/fonc.2022.996269
Cadossi R, Ronchetti M, Cadossi M. Locally enhanced chemotherapy by electroporation: clinical experiences and perspective of use of electrochemotherapy. Fu-ture Oncol Lond Engl. 2014 Apr;10(5):877–90.
https://doi.org/10.2217/fon.13.235 DOI: https://doi.org/10.2217/fon.13.235
Perrone AM, Galuppi A, Pirovano C, et al. Palliative electrochemotherapy in vulvar carci-noma: preliminary results of the ELECHTRA (Electrochemotherapy Vulvar Cancer) multicenter study. Cancers. 2019 May 12;11(5):E657.
https://doi.org/10.3390/cancers11050657 DOI: https://doi.org/10.3390/cancers11050657
Tranoulis A, Georgiou D, Founta C, et al. Use of electrochemotherapy in women with vul-var cancer to improve quality-of-life in the palliative setting: a meta-analysis. Int J Gynecol Cancer. 2020 Jan;30(1):107–14.
https://doi.org/10.1136/ijgc-2019-000868 DOI: https://doi.org/10.1136/ijgc-2019-000868
Corrado G, Cutillo G, Fragomeni SM, et al. Palliative electrochemotherapy in primary or recurrent vulvar cancer. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2020 Jul;30(7):927–31.
https://doi.org/10.1136/ijgc-2019-001178 DOI: https://doi.org/10.1136/ijgc-2019-001178
Perrone AM, Corrado G, Coada CA, et al. Electrochemotherapy with intravenous bleomy-cin for heavily pre-treated vulvar cancer patients. Int J Gynecol Cancer. 2023;33(4):473–81.
https://doi.org/10.1136/ijgc-2022-004127 DOI: https://doi.org/10.1136/ijgc-2022-004127
Vivod G, Bosnjak M, Kovacevic N, et al. Safety and feasibility of vulvar cancer treatment with electrochemotherapy. Cancers. 2023 Jun 7;15(12):3079.
https://doi.org/10.3390/cancers15123079 DOI: https://doi.org/10.3390/cancers15123079
Gehl J, Sersa G, Matthiessen LW, et al. Updated standard operating procedures for elec-trochemotherapy of cutaneous tumours and skin metastases. Acta Oncol Stockh Swed. 2018 Jul;57(7):874–82.
https://doi.org/10.1080/0284186X.2018.1454602 DOI: https://doi.org/10.1080/0284186X.2018.1454602
Jamsek C, Sersa G, Bosnjak M, et al. Long term response of electrochemotherapy with reduced dose of bleomycin in elderly patients with head and neck non-melanoma skin cancer. Radiol Oncol. 2020 Feb 19;54(1):79–85.
https://doi.org/10.2478/raon-2020-0009 DOI: https://doi.org/10.2478/raon-2020-0009
Campana LG, Clover AJP, Valpione S, et al. Recommendations for improving the quality of reporting clinical electrochemotherapy studies based on qualitative sys-tematic review. Radiol Oncol. 2016 Feb 16;50(1):1–13.
https://doi.org/10.1515/raon-2016-0006 DOI: https://doi.org/10.1515/raon-2016-0006
Oonk MHM, Planchamp F, Baldwin P, et al. European society of gynaecological oncology guidelines for the management of patients with vulvar cancer – update 2023. Int J Gynecol Cancer. 2023 Jul 3;33(7):1023–43.
https://doi.org/10.1136/ijgc-2023-004486 DOI: https://doi.org/10.1136/ijgc-2023-004486
Rogers LJ. Management of advanced squamous cell carcinoma of the vulva. Cancers. 2021 Dec 30;14(1):167.
https://doi.org/10.3390/cancers14010167 DOI: https://doi.org/10.3390/cancers14010167
Matsuo K, Mandelbaum RS, Adams CL, et al. Performance and outcome of pelvic exenter-ation for gynecologic malignancies: a population-based study. Gynecol Oncol. 2019 May;153(2):368–75.
https://doi.org/10.1016/j.ygyno.2019.02.002 DOI: https://doi.org/10.1016/j.ygyno.2019.02.002
Bonadies A, Bertozzi E, Cristiani R, et al. Electrochemotherapy in skin malignancies of head and neck cancer patients: clinical efficacy and aesthetic benefits. Acta Derm Venereol. 2019 Oct 24;99(13):1246–52.
https://doi.org/10.2340/00015555-3341 DOI: https://doi.org/10.2340/00015555-3341
Plaschke CC, Johannesen HH, Hansen RH, et al. The DAHANCA 32 study: electrochemo-therapy for recurrent mucosal head and neck cancer. Head Neck. 2019;41(2):329–39.
https://doi.org/10.1002/hed.25454 DOI: https://doi.org/10.1002/hed.25454
Heller R, Jaroszeski MJ, Reintgen DS, et al. Treatment of cutaneous and subcutaneous tumors with electrochemotherapy using intralesional bleomycin. Cancer. 1998 Jul 1;83(1):148–57. DOI: https://doi.org/10.1002/(SICI)1097-0142(19980701)83:1<148::AID-CNCR20>3.0.CO;2-W
https://doi.org/10.1002/(SICI)1097-0142(19980701)83:1%3C148::AID-CNCR20%3E3.0.CO;2-W
Rahm C, Adok C, Dahm-Kähler P, et al. Complications and risk factors in vulvar cancer surgery – a population-based study. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2022 Jun;48(6):1400–6.
https://doi.org/10.1016/j.ejso.2022.02.006 DOI: https://doi.org/10.1016/j.ejso.2022.02.006
Stanca M, Căpîlna DM, Căpîlna ME. Long-term survival, prognostic factors, and quality of life of patients undergoing pelvic exenteration for cervical cancer. Cancers. 2022 May 9;14(9):2346.
https://doi.org/10.3390/cancers14092346 DOI: https://doi.org/10.3390/cancers14092346
Tortorella L, Casarin J, Mara KC, et al. Prediction of short-term surgical complications in women undergoing pelvic exenteration for gynecological malignancies. Gynecol Oncol. 2019 Jan;152(1):151–6.
https://doi.org/10.1016/j.ygyno.2018.10.036 DOI: https://doi.org/10.1016/j.ygyno.2018.10.036
de Gregorio N, de Gregorio A, Ebner F, et al. Pelvic exenteration as ultimate ratio for gyne-cologic cancers: single-center analyses of 37 cases. Arch Gynecol Obstet. 2019 Jul;300(1):161–8.
https://doi.org/10.1007/s00404-019-05154-4 DOI: https://doi.org/10.1007/s00404-019-05154-4
Malandrone F, Bevilacqua F, Merola M, et al. The impact of vulvar cancer on psychosocial and sexual functioning: a literature review. Cancers. 2021 Dec 23;14(1):63.
https://doi.org/10.3390/cancers14010063 DOI: https://doi.org/10.3390/cancers14010063
Abbott-Anderson K, Kwekkeboom KL. A systematic review of sexual concerns reported by gynecological cancer survivors. Gynecol Oncol. 2012 Mar;124(3):477–89.
https://doi.org/10.1016/j.ygyno.2011.11.030 DOI: https://doi.org/10.1016/j.ygyno.2011.11.030
Wills A, Obermair A. A review of complications associated with the surgical treatment of vulvar cancer. Gynecol Oncol. 2013 Nov;131(2):467–79.
https://doi.org/10.1016/j.ygyno.2013.07.082 DOI: https://doi.org/10.1016/j.ygyno.2013.07.082
Wettergren L, Eriksson LE, Bergström C, et al. Prevalence and risk factors for sexual dys-function in young women following a cancer diagnosis – a population-based study. Acta Oncol Stockh Swed. 2022 Oct;61(10):1165–72.
https://doi.org/10.1080/0284186X.2022.2112283 DOI: https://doi.org/10.1080/0284186X.2022.2112283
Čebron Ž, Djokić M, Petrič M, et al. Intraoperative electrochemotherapy of the posterior resection surface after pancreaticoduodenectomy: preliminary results of a hybrid approach treatment of pancreatic cancer. Bioelectrochemistry Amst Neth. 2023 Sep 22;155:108576.
https://doi.org/10.1016/j.bioelechem.2023.108576 DOI: https://doi.org/10.1016/j.bioelechem.2023.108576
Benedik J, Ogorevc B, Brezar SK, et al. Comparison of general anesthesia and continuous intravenous sedation for electrochemotherapy of head and neck skin le-sions. Front Oncol. 2022;12:1011721.
https://doi.org/10.3389/fonc.2022.1011721 DOI: https://doi.org/10.3389/fonc.2022.1011721
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2023 Gregor Vivod, Masa Omerzel, Nina Kovacevic, Gorana Gasljevic, Ines Cilensek, Gregor Sersa, Maja Cemazar, Sebastjan Merlo
This work is licensed under a Creative Commons Attribution 4.0 International License.
