title: Electrochemotherapy in the treatment of metastatic malignant melanoma: a prospective cohort study by InspECT.
abstract: BACKGROUND
  (ECT) is an effective local treatment for cutaneous metastasis. Treatment involves the administration of chemotherapeutic drugs followed by delivery of electrical pulses to the tumour.
  
  
  OBJECTIVE
  To investigate the effectiveness of ECT in cutaneous metastases of melanoma and to identify factors that affect (beneficially or adversely) the outcome.
  
  
  METHODS
  Thirteen cancer centres in the International Network for Sharing Practices on Electrochemotherapy consecutively and prospectively uploaded data to a common database. ECT consisted of intratumoral or intravenous injection of bleomycin, followed by application of electric pulses under local or general anaesthesia.
  
  
  RESULTS
  In total, 151 patients with metastatic melanoma were identified from the database, 114 of whom had follow-up data of 60 days or more. Eighty-four of these patients (74%) experienced an overall response (OR = complete response + partial response). Overall, 394 lesions were treated, of which 306 (78%) showed OR, with 229 showing complete response (58%). In multivariate analysis, factors positively associated with overall response were coverage of deep margins, absence of visceral metastases, presence of lymphoedema and treatment of nonirradiated areas. Factors significantly associated with complete response to ECT treatment were coverage of deep margins, previous irradiation of the treated area and tumour size (< 3 cm). One-year overall survival in this cohort of patients was 67% (95% confidence interval 57-77%), while melanoma-specific survival was 74% (95% confidence interval 64-84%). No serious adverse events were reported, and the treatment was in general very well tolerated.
  
  
  CONCLUSIONS
  ECT is a highly effective local treatment for melanoma metastases in the skin, with no severe adverse effects noted in this study. In the presence of certain clinical factors, ECT may be considered for local tumour control as an alternative to established local treatments, or as an adjunct to systemic treatments.
authors.affiliation: Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kunte
authors.affiliation: Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Letulé
authors.affiliation: Center for Experimental Drug and Gene Electrotransfer, Department of Oncology, Copenhagen University Hospital Herlev, Herlev, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Gehl
authors.affiliation: Department of Plastic Surgery, Copenhagen University Hospital Herlev, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Dahlstroem
authors.affiliation: Department of Dermatology and Plastic Surgery, Dermatologic Clinic, University of Rome 'La Sapienza', Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Curatolo
authors.affiliation: Department of Dermatology and Plastic Surgery, Dermatologic Clinic, University of Rome 'La Sapienza', Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Rotunno
authors.affiliation: Department of Reconstructive Plastic Surgery, James Cook University Hospital, Middlesbrough, U.K.
authors.forename: T
authors.initials: T
authors.lastname: Muir
authors.affiliation: Department of Otolaryngology Head & Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Occhini
authors.affiliation: Department of Otolaryngology Head & Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Bertino
authors.affiliation: Department of Plastic Surgery, St George's Hospital, London, U.K.
authors.forename: B
authors.initials: B
authors.lastname: Powell
authors.affiliation: Department of Dermatology, Klinikum Wels-Grieskirchen, Wels, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Saxinger
authors.affiliation: Department of Dermatology, Klinikum Wels-Grieskirchen, Wels, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Lechner
authors.affiliation: Department of Plastic Surgery, Whiston Hospital, Prescot, Merseyside, U.K.
authors.forename: S-H
authors.initials: SH
authors.lastname: Liew
authors.affiliation: Department of Plastic Surgery, Whiston Hospital, Prescot, Merseyside, U.K.
authors.forename: R
authors.initials: R
authors.lastname: Pritchard-Jones
authors.affiliation: Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Rutkowski
authors.affiliation: Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Zdzienicki
authors.affiliation: Department of Plastic Surgery.
authors.forename: D
authors.initials: D
authors.lastname: Mowatt
authors.affiliation: Department of Clinical Oncology, Christie Hospital, NHS Foundation Trust, Manchester, U.K.
authors.forename: A J
authors.initials: AJ
authors.lastname: Sykes
authors.affiliation: Department of Plastic and Reconstructive Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, U.K.
authors.forename: A
authors.initials: A
authors.lastname: Orlando
authors.affiliation: Department of Plastic and Reconstructive Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, U.K.
authors.forename: G
authors.initials: G
authors.lastname: Mitsala
authors.affiliation: Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.|Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
authors.forename: C R
authors.initials: CR
authors.lastname: Rossi
authors.affiliation: Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.|Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Campana
authors.affiliation: Department of Medical Sciences, Dermatologic Clinic, University of Torino, Torino, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Brizio
authors.affiliation: Scientific and Medical Department, IGEA S.p.A., Carpi, Italy.
authors.forename: F
authors.initials: F
authors.lastname: de Terlizzi
authors.affiliation: Department of Medical Sciences, Dermatologic Clinic, University of Torino, Torino, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Quaglino
authors.affiliation: Department of Plastic Surgery, St George's Hospital, London, U.K.
authors.forename: J
authors.initials: J
authors.lastname: Odili
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000379:methods; D018450:Disease Progression; D053672:Electrochemotherapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004566:Electrodes; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D009362:Neoplasm Metastasis; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016896:Treatment Outcome; D047368:Tumor Burden