Neoadjuvant treatment by ECT in cutaneous malignant neoplastic lesions

Electrochemotherapy (ECT) is a local treatment and its use has been standardised for cutaneous nodules of any histological origin. In this study, we use ECT as a neoadjuvant therapy to reduce the size of neoplastic lesions to obtain an ideal cleavage plane where vital or very important vascular and/or nervous structures are separated from the tumour, thus allowing a radical surgical excision, which is otherwise unfeasible. In their retrospective study, the authors identified 41 patients who were treated at our institution with neoadjuvant intent. ECT was performed under general (30 patients, 73%), regional (9 patients, 22%) or local anaesthesia with sedation (2 patients, 5%). At a median time of 2 months (range, 0.3-9) after neoadjuvant ECT, all patients underwent surgical intervention to resect the residual tumour. Median reduction of tumour volume after ECT was 55% (range, 10%-65%). After ECT plus surgery, 25 patients (61%) had complete response (CR), 16 patients (39%) partial response (PR). The percentage of CR in patients with larger lesions (>100 mm) was 27%, in patients with smaller lesions (≤100 mm) was 73% (p = 0.0119). Major side effects after ECT were: bleeding and/or ulceration (54%) and pain (59%) naturally resolved within 1-2 months. Side effects observed after surgery were: necrosis of the flap (N = 3), a case of diastasis of the donor site. Median survival time in CR patients was 53 months (range, 4-108), whereas in PR survival was 23 months (range, 5-126), p = 0.0400. ECT represents a safe and effective therapeutic approach that could be effectively used for neoadjuvant purposes.