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Original research
Palliative electrochemotherapy in primary or recurrent vulvar cancer
  1. Giacomo Corrado1,
  2. Giuseppe Cutillo2,
  3. Simona Maria Fragomeni1,
  4. Valentina Bruno2,
  5. Luca Tagliaferri3,
  6. Emanuela Mancini2,
  7. Camilla Certelli2,
  8. Ida Paris1,
  9. Enrico Vizza2,
  10. Giovanni Scambia4 and
  11. Giorgia Garganese1,5
  1. 1 Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  2. 2 Department of Experimental Clinical Oncology, Gynaecologic Oncology Unit, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
  3. 3 Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia - Gemelli ART (Advanced Radiation Therapy), Interventional Oncology Center (IOC), Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  4. 4 Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
  5. 5 Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
  1. Correspondence to Dr Valentina Bruno, Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, Regina Elena Institute, Roma, Italy; valentina.bruno{at}ifo.gov.it

Abstract

Objective Since vulvar cancer is such a rare disease, the international experience with electrochemotherapy has been derived from only a few centers. The aim of this study was to evaluate clinical outcome and side effects profile with the use of electrochemotherapy in patients with primary or recurrent vulvar cancer.

Methods Data were retrospectively collected from November 2017 to November 2019 in two major Italian oncologic institutes: Regina Elena Institute and Fondazione Policlinico Universitario Agostino Gemelli IRCCS. Electrochemotherapy was offered in a palliative setting to patients with a primary or recurrent vulvar cancer who were not candidates for surgery or any other treatment, because of poor performance status or previous delivered treatments. All patients underwent general anesthesia. Electrical pulses were delivered using a pulse generator. Intravenous bleomycin was administered in conjunction with electrochemotherapy. Follow-up examinations were performed at 1, 3, and 6 months. Primary endpoint was to assess the response rate of electrochemotherapy as palliative treatment in patients with vulvar cancer.

Results A total of 15 patients were included in the study. Fourteen patients (93.3%) had a squamous cell carcinoma and one patient had vulvar carcinosarcoma. Ten patients (66.7 %) had a single lesion and 5 patients (33.3%) had multiple lesions. Median number of electrical pulses was 22 (range 3–42) and median operative time was 13 (range 7–20) min. No intra-procedure complications occurred. One patient had pneumonia during their post-operative stay. Overall response rate after 1 month was 80%. At the 3-month follow-up, 3 patients (20%) had disease progression, 3 patients (20%) had died from ongoing disease, 1 patient (6.7%) died for other reasons, whereas the other patients maintained their 1-month clinical response. A total of 8/13 patients (61.5%) were alive at 6-month follow-up, whereas 6/12 patients (50%) were alive at 1-year follow-up.

Conclusions Electrochemotherapy is a feasible, easy to perform, and reproducible procedure in patients with primary or recurrent vulvar cancer who are unable to undergo surgery. Survival after 1 year in this population was 50%. Electrochemotherapy may have a role in the management of vulvar cancer, especially as palliative treatment when other therapies are no longer applicable.

  • palliative care
  • vulvar neoplasms

https://doi.org/10.1136/ijgc-2019-001178

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    Footnotes

    • Contributors Authors' contributions are described in the article. Conceptualization: GC; methodology: VB; software: LT; validation: LT; formal analysis: EM; investigation: IP; resources: GS; data curation: IP; writing – original draft: GC; writing – review and editing: GC and SF; visualization: EV; supervision: GG; project administration: SF.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.