Evidenze scientifiche

Dallo Studio ESOPE in poi, ovvero dopo la standardizzazione della elettrochemioterapia e l’inizio della sua diffusione in oltre 150 Istituti Europei, l’evidenza della sua efficacia e dei benefici per i pazienti è stata pubblicata in oltre 750 contributi scientifici sulle più importanti riviste internazionali di medicina.

Data l’enorme mole di articoli scientifici, la nostra scelta è di riportare in questa area soltanto gli abstract (riassunto) delle più significative review e metanalisi relative alla elettrochemioterapia.

È possibile richiedere ulteriori approfondimenti contattandoci ai riferimenti riportati nella sezione Contatti.

INDICE DEI CONTENUTI

  1. Electrochemotherapy for Treatment of Cutaneous Breast Cancer Metastases: A Review
  2. The promising alliance of anti-cancer electrochemotherapy with immunotherapy
  3. Electrochemotherapy of mucosal head and neck tumors: a systematic review
  4. Electrochemotherapy in pancreatic adenocarcinoma treatment: pre-clinical and clinical studies
  5. Electrochemotherapy as a new approach on pancreatic cancer and on liver metastases
  6. Efficacy of Skin-Directed Therapy for Cutaneous Metastases From Advanced Cancer: A Meta-Analysis
  7. Locally enhanced chemotherapy by electroporation: clinical experiences and perspective of use of electrochemotherapy
  8. Antitumor effectiveness of electrochemotherapy: A systematic review and meta-analysis
  9. Antivascular effects of electrochemotherapy: implications in treatment of bleeding metastases
  10. Intraoperative Electrochemotherapy of Colorectal Liver Metastases
  11. Percutaneous electrochemotherapy in the treatment of portal vein tumor thrombosis at hepatic hilum in patients with hepatocellular carcinoma in cirrhosis: A feasibility study
  12. Electrochemotherapy in locally advanced pancreatic cancer: Preliminary results

1 - Electrochemotherapy for Treatment of Cutaneous Breast Cancer Metastases: A Review

Shramana M. Banerjee , Mohammed R.S. Keshtgar.

Division of Surgery and interventional Science, University College London, London, UK & Royal Free London NHS Foundation Trust, London, UK.

Arch Breast Cancer 2016; Vol. 3, No. 4: 108-117.

ABSTRACT

Background: Electrochemotherapy is a relatively new technique in the treatment of skin metastases that are not amenable to conventional therapy. Its use in breast cancer is now established in many European centers.

Methods: Published literature of electrochemotherapy in terms of its scientific basis, current clinical practice of breast cancer treatment providers, as well as the future directions for the technology has been reviewed.

Results: Collective global experience of the last 10 years has demonstrated Electrochemotherapy is a safe, well-tolerated and effective treatment of cutaneous breast cancer metastases and good outcome characteristics have been identified. However, successful treatment requires appropriate patient selection.

Conclusions: Electrochemotherapy is now established as a standard of care for cutaneous metastases. Its future use may extend to gene therapy and the treatment of visceral tumors.

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2 - The promising alliance of anti-cancer electrochemotherapy with immunotherapy

Christophe Y. Calvet & Lluis M. Mir.

Vectorology and Anticancer Therapies, UMR8203, CNRS, Univ. Paris-Sud, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France.

Cancer Metastasis Rev. 2016 Jun;35(2):165-77.

ABSTRACT

Anti-tumor electrochemotherapy, which consists in increasing anti-cancer drug uptake by means of electroporation, is now implanted in about 140 cancer treatment centers in Europe. Its use is supported by the English National Institute for Health and Care Excellence for the palliative treatment of skin metastases, and about 13,000 cancer patients were treated by this technology by the end of 2015. Efforts are now focused on turning this local anti-tumor treatment into a systemic one. Electrogenetherapy, that is the electroporationmediated transfer of therapeutic genes, is currently under clinical evaluation and has brought excitement to enlarge the anti-cancer armamentarium. Among the promising electrogenetherapy strategies, DNA vaccination and cytokine-based immunotherapy aim at stimulating anti-tumor immunity. We review here the interests and state of development of both electrochemotherapy and electrogenetherapy. We then emphasize the potent beneficial outcome of the combination of electrochemotherapy with immunotherapy, such as immune checkpoint inhibitors or strategies based on electrogenetherapy, to simultaneously achieve excellent local debulking anti-tumor responses and systemic anti-metastatic effects.

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3 - Electrochemotherapy of mucosal head and neck tumors: a systematic review

Christina Caroline Plaschke, Anita Gothelf, Julie Gehl & Irene Wessel.

Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Oncology, Section 5073, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Oncology, Center for Experimental Drug and Gene Electrotransfer, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark.

Acta Oncol. 2016 Nov;55(11):1266-1272.

ABSTRACT

Background: Electrochemotherapy, the combination of electroporation and chemotherapy, is mainly used in the palliative setting for treatment of cutaneous and subcutaneous metastases; however, new applications are continuously being explored. Patients with head and neck cancer are primarily treated with surgery and/or radio-chemotherapy. In the setting of local recurrence with no further curative treatment options available, electrochemotherapy could be of value. We therefore performed a systematic search of the present literature.

Materials and methods: Eligible studies presented data from patients with head and neck cancer treated across the mucosal surface with electrochemotherapy. The search resulted in 11 studies with a total of 72 patients.

Results: Overall complete response was reported as good, especially in primary small tumors. Side effects were minor in primary tumors whereas large, recurrent tumors displayed more frequent side effects and some serious adverse events. Design and structure of the studies differed considerably, making general comparisons difficult.

Conclusion: Few studies concerning electrochemotherapy on mucosal head and neck tumors are available and they are not easily comparable. Overall response to treatment is good; nonetheless, further systematic studies are warranted.

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4 - Electrochemotherapy in pancreatic adenocarcinoma treatment: pre-clinical and clinical studies

Sabrina Bimonte, Maddalena Leongito, Vincenza Granata, Antonio Barbieri, Vitale del Vecchio, Michela Falco, Aurelio Nasto, Vittorio Albino, Mauro Piccirillo, Raffaele Palaia, Alfonso Amore, Raimondo di Giacomo, Secondo Lastoria, Sergio Venanzio Setola, Roberta Fusco, Antonella Petrillo, Francesco Izzo.

Division of Abdominal Surgical Oncology, Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori “Fondazione G. Pascale”, IRCCS, Naples, Italy; Division of Radiology, Istituto Nazionale per lo studio e la cura dei Tumori “Fondazione G. Pascale”, IRCCS, Naples, Italy; S.S.D Sperimentazione Animale, Istituto Nazionale per lo studio e la cura dei Tumori “Fondazione G. Pascale”, IRCCS, Naples, Italy; Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori “Fondazione G.Pascale” IRCCS, Naples, Italy.

Acta Oncol. 2016 Nov;55(11):1266-1272.

ABSTRACT

Background: Pancreatic adenocarcinoma is currently one of the deadliest cancers with high mortality rate. This disease leads to an aggressive local invasion and early metastases, and is poorly responsive to treatment with chemotherapy or chemo-radiotherapy. Radical resection is still the only curative treatment for pancreatic cancer, but it is generally accepted that a multimodality strategy is necessary for its management. Therefore, new alternative therapies have been considered for local treatment.

Conclusions: Chemotherapeutic resistance in pancreatic cancer is associated to a low penetration of drugs into tumour cells due to the presence of fibrotic stroma surrounding cells. In order to increase the uptake of chemotherapeutic drugs into tumour cells, electrochemotherapy can be used for treatment of pancreatic adenocarcinoma leading to an increased tumour response rate. This review will summarize the published papers reported in literature on the efficacy and safety of electrochemotherapy in pre-clinical and clinical studies on pancreatic cancer.

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5 - Electrochemotherapy as a new approach on pancreatic cancer and on liver metastases

Tafuto S, von Arx C, De Divitiis C, Maura CT, Palaia R, Albino V, Fusco R, Membrini M, Petrillo A, Granata V, Izzo F; ENETS Center of Excellence Multidisciplinary Group for Neuroendocrine Tumors in Naples (Italy).

Department of Abdominal Oncology, Division of Medical Oncology, NCI “Fondazione G. Pascale”, Naples, Italy; Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy; Department of Abdominal Oncology, Division of Surgical Oncology, NCI “Fondazione G. Pascale”, Naples, Italy; Department of Diagnostic Imaging, NCI of Naples, “Fondazione G. Pascale”, Naples, Italy.

Int J Surg. 2015 Sep;21 Suppl 1:S78-82.

ABSTRACT

Electrochemotherapy is a local non-thermal treatment for cancer ablation. Currently, many studies and case report have investigated the differences in effectiveness of electrochemotherapy with respect to tumor type, chemotherapeutic drug, and route of drug administration. ESOPE trial validated standard operating procedures [SOP] for ECT using the Cliniporator device and demonstrated that ECT is a simple, highly efficacious, and cost-effective treatment of cutaneous and subcutaneous nodules from different primary tumors for cutaneous or superficial lesions. This review has the purpose to summarize current knowledge about clinical effectiveness of electrochemotherapy and future prospects regarding its use on pancreatic cancer and liver metastasis not only.

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6 - Efficacy of Skin-Directed Therapy for Cutaneous Metastases From Advanced Cancer: A Meta-Analysis

Daniel E. Spratt, Elizabeth A. Gordon Spratt, Shenhong Wu, Antonio DeRosa, Nancy Y. Lee, Mario E. Lacouture, and Christopher A. Barker.

Memorial Sloan-Kettering Cancer Center; New York University Langone Medical Center, New York; Stony Brook University Cancer Center, Stony Brook, NY.

J Clin Oncol. 2014 Oct 1;32(28):3144-55.

ABSTRACT

Purpose: To perform the first meta-analysis of the efficacy of skin-directed therapies for cutaneous metastases.

Methods: MEDLINE, EMBASE, The Cochrane Library, and ClinicalTrials.gov databases were searched for reports of prospective clinical studies published between 1960 and 2013 that assessed the response of skin-directed therapy for cutaneous metastases (47 of 2,955 unique studies were selected). Primary end points of the study were complete and objective response rates. Secondary analyses were preplanned and included subgroup analyses by skin-directed therapy, histology, and recurrence rates. Meta-analyses were performed with random-effect modeling, and extent of heterogeneity between studies was determined with the Cochran Q and I2 tests.

Results: After applying exclusion criteria, 47 prospective studies of 4,313 cutaneous metastases were assessed. Five skin-directed therapies were identified: electrochemotherapy, photodynamic therapy, radiotherapy, intralesional therapy, and topical therapy. Among all cutaneous metastases, complete response rate was 35.5% (95% CI, 27.6% to 44.3%) and objective response rate was 60.2% (95% CI, 50.6% to 69.0%). Overall recurrence rate was estimated to be 9.2% (95% CI, 3.7% to 21.2%). Melanoma and breast carcinoma comprised 96.8% of all cutaneous metastases studied and had similar objective response rates (54.5% [95% CI, 48.3% to 60.7%] and 54.0% [95% CI, 48.3% to 59.7%], respectively). Grade 3 toxicity was reported in less than 6% of patients.

Conclusion: Response to skin-directed therapy for cutaneous metastases is high but heterogeneous across treatment modalities, with low rates of recurrence post-treatment. Treatment was generally well tolerated and conferred improvements in quality of life. Standardization of response criteria for cutaneous metastases and treatment algorithms to optimally use the available skin-directed therapies are needed.

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7 - Locally enhanced chemotherapy by electroporation: clinical experiences and perspective of use of electrochemotherapy

Cadossi R, Ronchetti M, Cadossi M.

Clinical Research, IGEA SpA, Via Parmenide 10/A, Carpi, Italy.

Future Oncol. 2014 Apr;10(5):877-90.

ABSTRACT

Electroporation is used to enhance drug diffusion and gene delivery into the cytosol. The combination of electroporation and cytotoxic drugs, electrochemotherapy (ECT), is used to treat metastatic tumor nodules located at the skin and subcutaneous tissue. The objective response rate following a single session of treatment exceeds 80%, with minimal toxicity for the patients. The efficacy of ECT in the bone and visceral metastasis is currently investigated, and Phase II studies have been completed. ECT has been used to treat skin primary tumors, except melanoma, and is under investigation for locally advanced pancreatic cancer. Early evidence suggests that treatment of tumor nodules with ECT recruits components of the immune system and eliciting a systemic immune response against cancer is a challenging clinical perspective. Considering the proven safety in several different clinical applications electroporation should be viewed as a clinical platform technology with wide perspectives for use in ECT, gene therapy and DNA vaccination.

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8 - Antitumor effectiveness of electrochemotherapy: A systematic review and meta-analysis

B. Mali, T. Jarm, M. Snoj, G. Sersa, D. Miklavcic.

Department of Biomedical Engineering, Faculty of Electrical Engineering, University of Ljubljana, Trzaska 25, SI-1000 Ljubljana, Slovenia; Department of Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.

Eur J Surg Oncol. 2013 Jan;39(1):4-16.

ABSTRACT

Background: This systematic review has two purposes: to consolidate the current knowledge about clinical effectiveness of electrochemotherapy, a highly effective local therapy for cutaneous and subcutaneous tumors; and to investigate the differences in effectiveness of electrochemotherapy with respect to tumor type, chemotherapeutic drug, and route of drug administration.

Methods: All necessary steps for a systematic review were applied: formulation of research question, systematic search of literature, study selection and data extraction using independent screening process, assessment of risk of bias, and statistical data analysis using two-sided common statistical methods and meta-analysis. Studies were eligible for the review if they provided data about effectiveness of singlesession electrochemotherapy of cutaneous or subcutaneous tumors in various treatment conditions.

Results: In total, 44 studies involving 1894 tumors were included in the review. Data analysis confirmed that electrochemotherapy had significantly (p < .001) higher effectiveness (by more than 50%) than bleomycin or cisplatin alone. The effectiveness was significantly higher for intratumoral than for intravenous administration of bleomycin (p < .001 for CR%, p ¼ .028 for OR%). Bleomycin and cisplatin administered intratumorally resulted in equal effectiveness of electrochemotherapy. Electrochemotherapy was more effective in sarcoma than in melanoma or carcinoma tumors.

Conclusions: The results of this review shed new light on effectiveness of electrochemotherapy and can be used for prediction of tumor response to electrochemotherapy with respect to various treatment conditions and should be taken into account for further refinement of electrochemotherapy protocols.

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9 - Antivascular effects of electrochemotherapy: implications in treatment of bleeding metastases

Tomaz Jarm, Maja Cemazar, Damijan Miklavcic and Gregor Sersa.

University of Ljubljana, Faculty of Electrical Engineering, Trzaska 25, SI-1000 Ljubljana, Slovenia; Institute of Oncology Ljubljana, Zaloska 2, SI-1000 Ljubljana, Slovenia.

Expert Rev. Anticancer Ther. 10(5), 729–746 (2010).

ABSTRACT

Solid tumors of various etiologies can be treated efficiently by electrochemotherapy (ECT), a combined use of electroporation (EP) and chemotherapeutic drugs, such as bleomycin and cisplatin. EP alone and ECT in particular, induce a profound reduction in tumor blood flow, which contributes to the antitumor effect. After EP and ECT, the time course of blood flow changes and follows the same two-phase pattern. The first rapid and short-lived vasoconstriction phase is followed by the second much longer-lived phase resulting from disrupted cytoskeletal structures and a compromised barrier function of the microvascular endothelium. In the case of ECT, however, tumor vascular endothelial cells are also affected by the chemotherapeutic drug, which leads to irrecoverable damage to tumor vessels and to a further decrease in tumor blood flow within hours after application of ECT. Tumor cells surviving the direct effects of ECT are consequently exposed to lack of oxygen and nutrients and are pushed into the secondary cascade of induced cell death. Clinically, the antitumor effectiveness of ECT has been proven extensively in the treatment of melanoma metastases, with 70–80% complete responses. The antivascular effects of ECT were also exploited for palliative treatment of bleeding melanoma metastases, with immediate cessation of bleeding and very good antitumor effectiveness. The antivascular effect of ECT is of utmost importance for translation of ECT into the treatment of deep-seated tumors, especially in well vascularized organs, such as the liver, where it prevents bleeding of the treated area.

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10 - Intraoperative Electrochemotherapy of Colorectal Liver Metastases

Edhemovic I, Brecelj E, Gasljevic G, Marolt Music M, Gorjup V, Mali B, Jarm T, Kos B, Pavliha D, Grcar Kuzmanov B, Cemazar M, Snoj M, Miklavcic D, Gadzijev EM, Sersa G.

Institute of Oncology Ljubljana, Ljubljana, Slovenia - University Medical Center Ljubljana, Ljubljana, Slovenia - Department of Biomedical Engineering, Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia

J Surg Oncol. 2014 Sep;110(3):320-7

ABSTRACT

Background and Objectives: Electrochemotherapy is effective in treatment of various cutaneous tumors and could be translated into treatment of deep‐seated tumors. With this aim a prospective pilot study was conducted to evaluate feasibility, safety, and efficacy of intraoperative electrochemotherapy in the treatment of colorectal liver metastases.

Methods: Electrochemotherapy with bleomycin was performed during open surgery, by insertion of long needle electrodes into and around the tumor according to the individualized pretreatment plan.

Results: A 29 metastases in 16 patients were treated in 16 electrochemotherapy sessions. No immediate (intraoperative) and/or postoperative serious adverse events related to electrochemotherapy were observed. Radiological evaluation of all the treated metastases showed 85% complete responses and 15% partial responses. In a group of seven patients that underwent a second operation at 6–12 weeks after the first one, during which electrochemotherapy was performed, the histology of resected metastases treated by electrochemotherapy showed less viable tissue (P¼0.001) compared to non‐treated ones.

Conclusions: Electrochemotherapy of colorectal liver metastases proved to be feasible, safe, and efficient treatment modality, providing its specific place in difficult to treat metastases, located in the vicinity of major hepatic vessels, not amenable to surgery or radiofrequency ablation.

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11 - Percutaneous electrochemotherapy in the treatment of portal vein tumor thrombosis at hepatic hilum in patients with hepatocellular carcinoma in cirrhosis: A feasibility study

Luciano Tarantino, Giuseppina Busto, Aurelio Nasto, Raffaele Fristachi, Luigi Cacace, Maria Talamo, Catello Accardo, Sara Bortone, Paolo Gallo, Paolo Tarantino, Riccardo Aurelio Nasto, Matteo Nicola Dario Di Minno, Pasquale Ambrosino

Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, 84016 Pagani, Italy - Department of Oncology, Andrea Tortora Hospital, 84016 Pagani, Italy - Department of Surgery, Unit of General Surgery and Oncology, Andrea Tortora Hospital, 84016 Pagani, Italy - Department of Pathology, Andrea Tortora Hospital, 84016 Pagani, Italy, Department of Radiology, Andrea Tortora Hospital, 84016 Pagani, Italy - Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80138 Naples, Italy - Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy - Department of Clinical Medicine and Surgery, Federico II University, 80138 Naples, Italy

World J Gastroenterol. 2017 Feb 7;23(5):906-918.

ABSTRACT

Aim: To treated with electrochemotherapy (ECT) a prospective case series of patients with liver cirrhosis and Vp3-Vp4-portal vein tumor thrombus (PVTT) from hepatocellular carcinoma (HCC), in order to evaluate the feasibility, safety and efficacy of this new non thermal ablative technique in those patients.

Methods: Six patients (5 males and 1 female), aged 61-85 years (mean age, 70 years), four in Child-Pugh A and two in Child-Pugh B class, entered our study series. All patients were studied with three-phase computed tomography (CT), contrast enhanced ultrasound (CEUS) and ultrasound-guided percutaneous biopsy of the thrombus before ECT. All patients underwent ECT treatment (Cliniporator Vitae®, IGEA SpA, Carpi, Modena, Italy) of Vp3-Vp4 PVTT in a single session. At the end of the procedure a post-treatment biopsy of the thrombus was performed. Scheduled follow-up in all patients entailed: CEUS within 24 h after treatment; triphasic contrastenhanced CT and CEUS at 3 mo after treatment and every six months thereafter.

Results: Post-treatment CEUS showed complete absence of enhancement of the treated thrombus in all cases. Post treatment biopsy showed apoptosis and necrosis of tumor cells in all cases. The follow-up ranged from 9 to 20 mo (median, 14 mo). In 2 patients, the followup CT and CEUS demonstrated complete patency of the treated portal vein. Other 3 patients showed a persistent avascular non-tumoral shrinked thrombus at CEUS and CT during follow-up. No local recurrence was observed at follow-up CT and CEUS in 5/6 patients. One patient was lost to follow-up because of death from gastrointestinal hemorrage 5 wk after ECT.

Conclusion: In patients with cirrhosis, ECT seems effective and safe for curative treatment of Vp3-Vp4 PVTT from HCC.

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11 - Percutaneous electrochemotherapy in the treatment of portal vein tumor thrombosis at hepatic hilum in patients with hepatocellular carcinoma in cirrhosis: A feasibility study

Luciano Tarantino, Giuseppina Busto, Aurelio Nasto, Raffaele Fristachi, Luigi Cacace, Maria Talamo, Catello Accardo, Sara Bortone, Paolo Gallo, Paolo Tarantino, Riccardo Aurelio Nasto, Matteo Nicola Dario Di Minno, Pasquale Ambrosino

Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, 84016 Pagani, Italy - Department of Oncology, Andrea Tortora Hospital, 84016 Pagani, Italy - Department of Surgery, Unit of General Surgery and Oncology, Andrea Tortora Hospital, 84016 Pagani, Italy - Department of Pathology, Andrea Tortora Hospital, 84016 Pagani, Italy, Department of Radiology, Andrea Tortora Hospital, 84016 Pagani, Italy - Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80138 Naples, Italy - Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy - Department of Clinical Medicine and Surgery, Federico II University, 80138 Naples, Italy

World J Gastroenterol. 2017 Feb 7;23(5):906-918.

ABSTRACT

Aim: To treated with electrochemotherapy (ECT) a prospective case series of patients with liver cirrhosis and Vp3-Vp4-portal vein tumor thrombus (PVTT) from hepatocellular carcinoma (HCC), in order to evaluate the feasibility, safety and efficacy of this new non thermal ablative technique in those patients.

Methods: Six patients (5 males and 1 female), aged 61-85 years (mean age, 70 years), four in Child-Pugh A and two in Child-Pugh B class, entered our study series. All patients were studied with three-phase computed tomography (CT), contrast enhanced ultrasound (CEUS) and ultrasound-guided percutaneous biopsy of the thrombus before ECT. All patients underwent ECT treatment (Cliniporator Vitae®, IGEA SpA, Carpi, Modena, Italy) of Vp3-Vp4 PVTT in a single session. At the end of the procedure a post-treatment biopsy of the thrombus was performed. Scheduled follow-up in all patients entailed: CEUS within 24 h after treatment; triphasic contrastenhanced CT and CEUS at 3 mo after treatment and every six months thereafter.

Results: Post-treatment CEUS showed complete absence of enhancement of the treated thrombus in all cases. Post treatment biopsy showed apoptosis and necrosis of tumor cells in all cases. The follow-up ranged from 9 to 20 mo (median, 14 mo). In 2 patients, the followup CT and CEUS demonstrated complete patency of the treated portal vein. Other 3 patients showed a persistent avascular non-tumoral shrinked thrombus at CEUS and CT during follow-up. No local recurrence was observed at follow-up CT and CEUS in 5/6 patients. One patient was lost to follow-up because of death from gastrointestinal hemorrage 5 wk after ECT.

Conclusion: In patients with cirrhosis, ECT seems effective and safe for curative treatment of Vp3-Vp4 PVTT from HCC.

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12 - Percutaneous electrochemotherapy in the treatment of portal vein tumor thrombosis at hepatic hilum in patients with hepatocellular carcinoma in cirrhosis: A feasibility study

Luciano Tarantino, Giuseppina Busto, Aurelio Nasto, Raffaele Fristachi, Luigi Cacace, Maria Talamo, Catello Accardo, Sara Bortone, Paolo Gallo, Paolo Tarantino, Riccardo Aurelio Nasto, Matteo Nicola Dario Di Minno, Pasquale Ambrosino

Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, 84016 Pagani, Italy - Department of Oncology, Andrea Tortora Hospital, 84016 Pagani, Italy - Department of Surgery, Unit of General Surgery and Oncology, Andrea Tortora Hospital, 84016 Pagani, Italy - Department of Pathology, Andrea Tortora Hospital, 84016 Pagani, Italy, Department of Radiology, Andrea Tortora Hospital, 84016 Pagani, Italy - Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80138 Naples, Italy - Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy - Department of Clinical Medicine and Surgery, Federico II University, 80138 Naples, Italy

World J Gastroenterol. 2017 Feb 7;23(5):906-918.

ABSTRACT

Aim: To treated with electrochemotherapy (ECT) a prospective case series of patients with liver cirrhosis and Vp3-Vp4-portal vein tumor thrombus (PVTT) from hepatocellular carcinoma (HCC), in order to evaluate the feasibility, safety and efficacy of this new non thermal ablative technique in those patients.

Methods: Six patients (5 males and 1 female), aged 61-85 years (mean age, 70 years), four in Child-Pugh A and two in Child-Pugh B class, entered our study series. All patients were studied with three-phase computed tomography (CT), contrast enhanced ultrasound (CEUS) and ultrasound-guided percutaneous biopsy of the thrombus before ECT. All patients underwent ECT treatment (Cliniporator Vitae®, IGEA SpA, Carpi, Modena, Italy) of Vp3-Vp4 PVTT in a single session. At the end of the procedure a post-treatment biopsy of the thrombus was performed. Scheduled follow-up in all patients entailed: CEUS within 24 h after treatment; triphasic contrastenhanced CT and CEUS at 3 mo after treatment and every six months thereafter.

Results: Post-treatment CEUS showed complete absence of enhancement of the treated thrombus in all cases. Post treatment biopsy showed apoptosis and necrosis of tumor cells in all cases. The follow-up ranged from 9 to 20 mo (median, 14 mo). In 2 patients, the followup CT and CEUS demonstrated complete patency of the treated portal vein. Other 3 patients showed a persistent avascular non-tumoral shrinked thrombus at CEUS and CT during follow-up. No local recurrence was observed at follow-up CT and CEUS in 5/6 patients. One patient was lost to follow-up because of death from gastrointestinal hemorrage 5 wk after ECT.

Conclusion: In patients with cirrhosis, ECT seems effective and safe for curative treatment of Vp3-Vp4 PVTT from HCC.

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