Electrochemotherapy in the Treatment of Cutaneous Metastases from Breast Cancer: A Multicenter Cohort Analysis
Identifieur interne : 001E43 ( Main/Exploration ); précédent : 001E42; suivant : 001E44Electrochemotherapy in the Treatment of Cutaneous Metastases from Breast Cancer: A Multicenter Cohort Analysis
Auteurs : C. Cabula [Italie] ; L. G. Campana [Italie] ; G. Grilz [Italie] ; S. Galuppo [Italie] ; R. Bussone [Italie] ; L. De Meo [Italie] ; A. Bonadies [Italie] ; P. Curatolo [Italie] ; M. De Laurentiis [Italie] ; M. Renne [Italie] ; S. Valpione [Italie] ; T. Fabrizio [Italie] ; N. Solari [Italie] ; M. Guida [Italie] ; A. Santoriello [Italie] ; M. D Iuto [Italie] ; R. Agresti [Italie]Source :
- Annals of Surgical Oncology [ 1068-9265 ] ; 2015.
Abstract
The management of breast cancer (BC) skin metastases represents a therapeutic challenge. Electrochemotherapy (ECT) combines the administration of bleomycin with temporary permeabilization induced by locally administered electric pulses. Preliminary experience with ECT in BC patients is encouraging.
A total of 125 patients with BC skin metastases who underwent ECT between 2010 and 2013 were enrolled onto a multicenter retrospective cohort study. The treatment was administered following the European Standard Operative Procedures of Electrochemotherapy. Tumor response was clinically assessed adapting the Response Evaluation Criteria in Solid Tumors, and toxicity was evaluated according to Common Terminology Criteria for Adverse Events 4.0. Cox regression analysis was used to identify predictive factors.
Response was evaluable in 113 patients for 214 tumors (median 1 per patient, range 1–3). The overall response rate after 2 months was 90.2 %, while the complete response (CR) rate was 58.4 %. In multivariate analysis, small tumor size (
In this study, small tumor size, absence of visceral metastases, estrogen receptor positivity, and low Ki-67 index were predictors of CR after ECT. Patients who experienced CR had durable local control. ECT represents a valuable skin-directed therapy for selected patients with BC.
Url:
DOI: 10.1245/s10434-015-4779-6
PubMed: 26242370
PubMed Central: 4686551
Affiliations:
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Campana</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Veneto Institute of Oncology IOV-IRCCS, Padua, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Veneto Institute of Oncology IOV-IRCCS, Padua</wicri:regionArea><wicri:noRegion>Padua</wicri:noRegion></affiliation></author><author><name sortKey="Grilz, G" sort="Grilz, G" uniqKey="Grilz G" first="G." last="Grilz">G. Grilz</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Breast Surgery Unit, Ospedale Le Molinette, Turin, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Breast Surgery Unit, Ospedale Le Molinette, Turin</wicri:regionArea><placeName><settlement type="city">Turin</settlement><region type="région" nuts="2">Piémont</region></placeName></affiliation></author><author><name sortKey="Galuppo, S" sort="Galuppo, S" uniqKey="Galuppo S" first="S." last="Galuppo">S. 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De Meo</name><affiliation wicri:level="1"><nlm:aff id="Aff4">Humanitas-Centro Catanese di Oncologia, Catania, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Humanitas-Centro Catanese di Oncologia, Catania</wicri:regionArea><wicri:noRegion>Catania</wicri:noRegion></affiliation></author><author><name sortKey="Bonadies, A" sort="Bonadies, A" uniqKey="Bonadies A" first="A." last="Bonadies">A. Bonadies</name><affiliation wicri:level="3"><nlm:aff id="Aff5">Plastic Surgery Unit, San Gallicano Dermatologic Institute, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Plastic Surgery Unit, San Gallicano Dermatologic Institute, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Curatolo, P" sort="Curatolo, P" uniqKey="Curatolo P" first="P." last="Curatolo">P. 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Renne</name><affiliation wicri:level="1"><nlm:aff id="Aff8">Fondazione T. Campanella, Catanzaro, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Fondazione T. Campanella, Catanzaro</wicri:regionArea><wicri:noRegion>Catanzaro</wicri:noRegion></affiliation></author><author><name sortKey="Valpione, S" sort="Valpione, S" uniqKey="Valpione S" first="S." last="Valpione">S. Valpione</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Veneto Institute of Oncology IOV-IRCCS, Padua, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Veneto Institute of Oncology IOV-IRCCS, Padua</wicri:regionArea><wicri:noRegion>Padua</wicri:noRegion></affiliation></author><author><name sortKey="Fabrizio, T" sort="Fabrizio, T" uniqKey="Fabrizio T" first="T." last="Fabrizio">T. Fabrizio</name><affiliation wicri:level="1"><nlm:aff id="Aff9">Plastic Surgery Unit, IRCCS, Referral Cancer Center of Basilicata, Rionero in Vulture, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Plastic Surgery Unit, IRCCS, Referral Cancer Center of Basilicata, Rionero in Vulture</wicri:regionArea><wicri:noRegion>Rionero in Vulture</wicri:noRegion></affiliation></author><author><name sortKey="Solari, N" sort="Solari, N" uniqKey="Solari N" first="N." last="Solari">N. Solari</name><affiliation wicri:level="1"><nlm:aff id="Aff10">Surgical Unit 1, IRCCS San Martino-IST, Genoa, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Surgical Unit 1, IRCCS San Martino-IST, Genoa</wicri:regionArea><wicri:noRegion>Genoa</wicri:noRegion></affiliation></author><author><name sortKey="Guida, M" sort="Guida, M" uniqKey="Guida M" first="M." last="Guida">M. Guida</name><affiliation wicri:level="1"><nlm:aff id="Aff11">Medical Oncology Unit, Istituto dei Tumori, Bari, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Medical Oncology Unit, Istituto dei Tumori, Bari</wicri:regionArea><wicri:noRegion>Bari</wicri:noRegion></affiliation></author><author><name sortKey="Santoriello, A" sort="Santoriello, A" uniqKey="Santoriello A" first="A." last="Santoriello">A. Santoriello</name><affiliation wicri:level="1"><nlm:aff id="Aff12">Department of Medicine and Surgery, “Federico II” University, Naples, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Medicine and Surgery, “Federico II” University, Naples</wicri:regionArea><wicri:noRegion>Naples</wicri:noRegion></affiliation></author><author><name sortKey="D Iuto, M" sort="D Iuto, M" uniqKey="D Iuto M" first="M." last="D Iuto">M. 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Agresti</name><affiliation wicri:level="3"><nlm:aff id="Aff14">Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan</wicri:regionArea><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26242370</idno><idno type="pmc">4686551</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4686551</idno><idno type="RBID">PMC:4686551</idno><idno type="doi">10.1245/s10434-015-4779-6</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000C04</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000C04</idno><idno type="wicri:Area/Pmc/Curation">000C03</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000C03</idno><idno type="wicri:Area/Pmc/Checkpoint">001300</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">001300</idno><idno type="wicri:Area/Ncbi/Merge">007711</idno><idno type="wicri:Area/Ncbi/Curation">007711</idno><idno type="wicri:Area/Ncbi/Checkpoint">007711</idno><idno type="wicri:doubleKey">1068-9265:2015:Cabula C:electrochemotherapy:in:the</idno><idno type="wicri:Area/Main/Merge">001E46</idno><idno type="wicri:Area/Main/Curation">001E43</idno><idno type="wicri:Area/Main/Exploration">001E43</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Electrochemotherapy in the Treatment of Cutaneous Metastases from Breast Cancer: A Multicenter Cohort Analysis</title><author><name sortKey="Cabula, C" sort="Cabula, C" uniqKey="Cabula C" first="C." last="Cabula">C. Cabula</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Oncologic Surgery, Ospedale Oncologico A. Businco, Cagliari, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Oncologic Surgery, Ospedale Oncologico A. Businco, Cagliari</wicri:regionArea><wicri:noRegion>Cagliari</wicri:noRegion></affiliation></author><author><name sortKey="Campana, L G" sort="Campana, L G" uniqKey="Campana L" first="L. G." last="Campana">L. G. Campana</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Veneto Institute of Oncology IOV-IRCCS, Padua, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Veneto Institute of Oncology IOV-IRCCS, Padua</wicri:regionArea><wicri:noRegion>Padua</wicri:noRegion></affiliation></author><author><name sortKey="Grilz, G" sort="Grilz, G" uniqKey="Grilz G" first="G." last="Grilz">G. Grilz</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Breast Surgery Unit, Ospedale Le Molinette, Turin, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Breast Surgery Unit, Ospedale Le Molinette, Turin</wicri:regionArea><placeName><settlement type="city">Turin</settlement><region type="région" nuts="2">Piémont</region></placeName></affiliation></author><author><name sortKey="Galuppo, S" sort="Galuppo, S" uniqKey="Galuppo S" first="S." last="Galuppo">S. Galuppo</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Veneto Institute of Oncology IOV-IRCCS, Padua, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Veneto Institute of Oncology IOV-IRCCS, Padua</wicri:regionArea><wicri:noRegion>Padua</wicri:noRegion></affiliation></author><author><name sortKey="Bussone, R" sort="Bussone, R" uniqKey="Bussone R" first="R." last="Bussone">R. Bussone</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Breast Surgery Unit, Ospedale Le Molinette, Turin, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Breast Surgery Unit, Ospedale Le Molinette, Turin</wicri:regionArea><placeName><settlement type="city">Turin</settlement><region type="région" nuts="2">Piémont</region></placeName></affiliation></author><author><name sortKey="De Meo, L" sort="De Meo, L" uniqKey="De Meo L" first="L." last="De Meo">L. De Meo</name><affiliation wicri:level="1"><nlm:aff id="Aff4">Humanitas-Centro Catanese di Oncologia, Catania, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Humanitas-Centro Catanese di Oncologia, Catania</wicri:regionArea><wicri:noRegion>Catania</wicri:noRegion></affiliation></author><author><name sortKey="Bonadies, A" sort="Bonadies, A" uniqKey="Bonadies A" first="A." last="Bonadies">A. Bonadies</name><affiliation wicri:level="3"><nlm:aff id="Aff5">Plastic Surgery Unit, San Gallicano Dermatologic Institute, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Plastic Surgery Unit, San Gallicano Dermatologic Institute, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Curatolo, P" sort="Curatolo, P" uniqKey="Curatolo P" first="P." last="Curatolo">P. Curatolo</name><affiliation wicri:level="3"><nlm:aff id="Aff6">Dermatology and Plastic Surgery Department, La Sapienza University, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Dermatology and Plastic Surgery Department, La Sapienza University, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="De Laurentiis, M" sort="De Laurentiis, M" uniqKey="De Laurentiis M" first="M." last="De Laurentiis">M. De Laurentiis</name><affiliation wicri:level="1"><nlm:aff id="Aff7">Seconda Università di Napoli, Naples, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Seconda Università di Napoli, Naples</wicri:regionArea><wicri:noRegion>Naples</wicri:noRegion></affiliation></author><author><name sortKey="Renne, M" sort="Renne, M" uniqKey="Renne M" first="M." last="Renne">M. Renne</name><affiliation wicri:level="1"><nlm:aff id="Aff8">Fondazione T. Campanella, Catanzaro, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Fondazione T. Campanella, Catanzaro</wicri:regionArea><wicri:noRegion>Catanzaro</wicri:noRegion></affiliation></author><author><name sortKey="Valpione, S" sort="Valpione, S" uniqKey="Valpione S" first="S." last="Valpione">S. Valpione</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Veneto Institute of Oncology IOV-IRCCS, Padua, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Veneto Institute of Oncology IOV-IRCCS, Padua</wicri:regionArea><wicri:noRegion>Padua</wicri:noRegion></affiliation></author><author><name sortKey="Fabrizio, T" sort="Fabrizio, T" uniqKey="Fabrizio T" first="T." last="Fabrizio">T. Fabrizio</name><affiliation wicri:level="1"><nlm:aff id="Aff9">Plastic Surgery Unit, IRCCS, Referral Cancer Center of Basilicata, Rionero in Vulture, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Plastic Surgery Unit, IRCCS, Referral Cancer Center of Basilicata, Rionero in Vulture</wicri:regionArea><wicri:noRegion>Rionero in Vulture</wicri:noRegion></affiliation></author><author><name sortKey="Solari, N" sort="Solari, N" uniqKey="Solari N" first="N." last="Solari">N. Solari</name><affiliation wicri:level="1"><nlm:aff id="Aff10">Surgical Unit 1, IRCCS San Martino-IST, Genoa, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Surgical Unit 1, IRCCS San Martino-IST, Genoa</wicri:regionArea><wicri:noRegion>Genoa</wicri:noRegion></affiliation></author><author><name sortKey="Guida, M" sort="Guida, M" uniqKey="Guida M" first="M." last="Guida">M. Guida</name><affiliation wicri:level="1"><nlm:aff id="Aff11">Medical Oncology Unit, Istituto dei Tumori, Bari, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Medical Oncology Unit, Istituto dei Tumori, Bari</wicri:regionArea><wicri:noRegion>Bari</wicri:noRegion></affiliation></author><author><name sortKey="Santoriello, A" sort="Santoriello, A" uniqKey="Santoriello A" first="A." last="Santoriello">A. Santoriello</name><affiliation wicri:level="1"><nlm:aff id="Aff12">Department of Medicine and Surgery, “Federico II” University, Naples, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Medicine and Surgery, “Federico II” University, Naples</wicri:regionArea><wicri:noRegion>Naples</wicri:noRegion></affiliation></author><author><name sortKey="D Iuto, M" sort="D Iuto, M" uniqKey="D Iuto M" first="M." last="D Iuto">M. D Iuto</name><affiliation wicri:level="1"><nlm:aff id="Aff13">Breast Surgery Unit, Istituto Nazionale Tumori “Pascale”, Naples, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Breast Surgery Unit, Istituto Nazionale Tumori “Pascale”, Naples</wicri:regionArea><wicri:noRegion>Naples</wicri:noRegion></affiliation></author><author><name sortKey="Agresti, R" sort="Agresti, R" uniqKey="Agresti R" first="R." last="Agresti">R. Agresti</name><affiliation wicri:level="3"><nlm:aff id="Aff14">Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan</wicri:regionArea><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author></analytic><series><title level="j">Annals of Surgical Oncology</title><idno type="ISSN">1068-9265</idno><idno type="eISSN">1534-4681</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The management of breast cancer (BC) skin metastases represents a therapeutic challenge. Electrochemotherapy (ECT) combines the administration of bleomycin with temporary permeabilization induced by locally administered electric pulses. Preliminary experience with ECT in BC patients is encouraging.</p></sec><sec><title>Methods</title><p>A total of 125 patients with BC skin metastases who underwent ECT between 2010 and 2013 were enrolled onto a multicenter retrospective cohort study. The treatment was administered following the European Standard Operative Procedures of Electrochemotherapy. Tumor response was clinically assessed adapting the Response Evaluation Criteria in Solid Tumors, and toxicity was evaluated according to Common Terminology Criteria for Adverse Events 4.0. Cox regression analysis was used to identify predictive factors.</p></sec><sec><title>Results</title><p>Response was evaluable in 113 patients for 214 tumors (median 1 per patient, range 1–3). The overall response rate after 2 months was 90.2 %, while the complete response (CR) rate was 58.4 %. In multivariate analysis, small tumor size (<italic>P</italic> < 0.001), absence of visceral metastases (<italic>P</italic> = 0.001), estrogen receptor positivity (<italic>P</italic> = 0.016), and low Ki-67 index (<italic>P</italic> = 0.024) were significantly associated with CR. In the first 48 h, 10.4 % of patients reported severe skin pain. Dermatologic toxicity included grade 3 skin ulceration (8.0 %) and grade 2 skin hyperpigmentation (8.8 %). Tumor 1-year local progression-free survival was 86.2 % (95 % confidence interval 79.3–93.8) and 96.4 % (95 % confidence interval 91.6–100) in the subgroup of those with CR.</p></sec><sec><title>Conclusions</title><p>In this study, small tumor size, absence of visceral metastases, estrogen receptor positivity, and low Ki-67 index were predictors of CR after ECT. Patients who experienced CR had durable local control. ECT represents a valuable skin-directed therapy for selected patients with BC.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Zagar, Tm" uniqKey="Zagar T">TM Zagar</name></author><author><name sortKey="Higgins, Ka" uniqKey="Higgins K">KA Higgins</name></author><author><name sortKey="Miles, Ef" uniqKey="Miles E">EF Miles</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Oldenborg, S" uniqKey="Oldenborg S">S Oldenborg</name></author><author><name sortKey="Van Os, Rm" uniqKey="Van Os R">RM Van Os</name></author><author><name sortKey="Van Rij, Cm" uniqKey="Van Rij C">CM Van Rij</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Guarneri, V" uniqKey="Guarneri V">V Guarneri</name></author><author><name sortKey="Conte, P" uniqKey="Conte P">P Conte</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Leonard, R" uniqKey="Leonard R">R 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Cabula</name></noRegion><name sortKey="Agresti, R" sort="Agresti, R" uniqKey="Agresti R" first="R." last="Agresti">R. Agresti</name><name sortKey="Bonadies, A" sort="Bonadies, A" uniqKey="Bonadies A" first="A." last="Bonadies">A. Bonadies</name><name sortKey="Bussone, R" sort="Bussone, R" uniqKey="Bussone R" first="R." last="Bussone">R. Bussone</name><name sortKey="Campana, L G" sort="Campana, L G" uniqKey="Campana L" first="L. G." last="Campana">L. G. Campana</name><name sortKey="Curatolo, P" sort="Curatolo, P" uniqKey="Curatolo P" first="P." last="Curatolo">P. Curatolo</name><name sortKey="D Iuto, M" sort="D Iuto, M" uniqKey="D Iuto M" first="M." last="D Iuto">M. D Iuto</name><name sortKey="De Laurentiis, M" sort="De Laurentiis, M" uniqKey="De Laurentiis M" first="M." last="De Laurentiis">M. De Laurentiis</name><name sortKey="De Meo, L" sort="De Meo, L" uniqKey="De Meo L" first="L." last="De Meo">L. De Meo</name><name sortKey="Fabrizio, T" sort="Fabrizio, T" uniqKey="Fabrizio T" first="T." last="Fabrizio">T. Fabrizio</name><name sortKey="Galuppo, S" sort="Galuppo, S" uniqKey="Galuppo S" first="S." last="Galuppo">S. Galuppo</name><name sortKey="Grilz, G" sort="Grilz, G" uniqKey="Grilz G" first="G." last="Grilz">G. Grilz</name><name sortKey="Guida, M" sort="Guida, M" uniqKey="Guida M" first="M." last="Guida">M. Guida</name><name sortKey="Renne, M" sort="Renne, M" uniqKey="Renne M" first="M." last="Renne">M. Renne</name><name sortKey="Santoriello, A" sort="Santoriello, A" uniqKey="Santoriello A" first="A." last="Santoriello">A. Santoriello</name><name sortKey="Solari, N" sort="Solari, N" uniqKey="Solari N" first="N." last="Solari">N. Solari</name><name sortKey="Valpione, S" sort="Valpione, S" uniqKey="Valpione S" first="S." last="Valpione">S. Valpione</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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