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Bleomycin electrosclerotherapy (BEST) for the treatment of vascular malformations. An International Network for Sharing Practices on Electrochemotherapy (InspECT) study group report Cover

Bleomycin electrosclerotherapy (BEST) for the treatment of vascular malformations. An International Network for Sharing Practices on Electrochemotherapy (InspECT) study group report

Radiology and Oncology
Volume 57 (2023): Issue 2 (June 2023)
By:
Open Access
|Jun 2023

Figures & Tables

FIGURE 1.

Treatment of vascularized melanoma metastasis by electrochemotherapy. (A) Highly vascularized tumor before treatment. (B) Bleeding due to electrode insertion after application of electric pulses to the tumor. (C) Bleeding stopped immediately after electric pulse application.
Treatment of vascularized melanoma metastasis by electrochemotherapy. (A) Highly vascularized tumor before treatment. (B) Bleeding due to electrode insertion after application of electric pulses to the tumor. (C) Bleeding stopped immediately after electric pulse application.

FIGURE 2.

Patient treated by BEST. Axial T2-weighted, fat-saturated MRI with hyperintense (arrow) gluteal venous malformation before treatment (A). Axial T2-weighted, fat-saturated MRI of the same region 4 months after treatment. The main part of the venous malformation is occluded (B). Photography before (C) and after the treatment (D).
Patient treated by BEST. Axial T2-weighted, fat-saturated MRI with hyperintense (arrow) gluteal venous malformation before treatment (A). Axial T2-weighted, fat-saturated MRI of the same region 4 months after treatment. The main part of the venous malformation is occluded (B). Photography before (C) and after the treatment (D).

Clinical studies and case reports using bleomycin electrosclerotherapy40,41,42,43,44,45

ReferenceType of malformationN of ptsBleomycin dose and concentrationElectrodes usedN of pulse applicationsResponseComment
McMorrow et al., Br J Oral and Maxillofacial Surg 201744Venous malformation1Reduced dose: 1/3 of the standard doseNot reportedNot reportedConsiderable improvement after 6 unsuccessful sessions with bleomycinCase report with poor respiratory function
Horbach et al., Dermatologic Surgery 202045Hypertrophic capillary malformations5 pts. (out of 20 planned)0.25 mg or units/cm3Plate & needleNot reported7–8 weeksDEROI (changes in colorimetry)Flux in ROI (in Perfusion Units)Randomized controlled pilot trial
Dalmady et al., Pediatrics 202043Lymphatic malformation10.5 mg/kg (5.4 mg)Needle1st session: 68 applications2nd session: 74 applications63% growth-corrected volume decrease.No recurrence at 18 months Follow upCase report
Wohlgemuth et al., Journal of Vascular Surgery 202140Venous malformations17 pts. (20 lesions)Calculated based on the size of the lesion.C = 0.25 mg/mL Intralesional injection (25% concentration of standard bleomycin sclerotherapy)Needle & fingerNot reported3-month post-therapy Changes in volume MRI: Volume reduction,%:
> 90%9 lesionsRetrospective observational case study
> 70% in < 90%6 lesions
> 50% in < 70%2 lesions
< 35%2 lesions
No response1 lesion
Kostusiak et al., Dermatologic Surgery 202242Various vascular malformations30 pts.VM: 17AVM: 3CVMLM: 2Mixed: 2Calculated based on the size of the lesion.Bleomycin mixed with 1 mL plain 1% lidocaineDose not reportedNeedle & fingerNot reported17 Complete Response7: significant improvement1: moderate improvement1: minor response1: no response3: active follow upProspective observational case studyElectrosclerotherapy offered to non-responding patients to standard bleomycin
Krt et al., Front Oncol 202241Arteriovenous malformation1750 IU BLM intralesionalPlate15CR 18 months after BEST Case report

International Society for the Study of Vascular Anomalies (ISSVA) classification for vascular anomalies 2018

VASCULAR TUMORSVASCULAR MALFORMATIONS
BenignLocally aggressiveMalignantSimpleCombined
Infantile hemangiomaKaposiform hemangioendothelioma Capillary malformation (CM)CVM, CLM
Congenital hemangiomaRetiform hemangioendothelioma Lymphatic malformation (LM)LVM. CLVM
Tufted hemangiomaPILA. Dabska tumorEpithelioid hemangioendotheliomaVenous malformation (VM)CAVM
Spindle-cell hemangiomaComposite hemangioendotheliomaAngiosarcomaArteriovenous malformation (AVM)
Epithelioid hemangiomaKaposi sarcoma Arteriovenous fistulaCLAVM
Pyogenic granuloma
DOI: https://doi.org/10.2478/raon-2023-0029 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
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Language: English
Page range: 141 - 149
Submitted on: May 26, 2023
Accepted on: Jun 3, 2023
Published on: Jun 21, 2023
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 times per year
Keywords:
vascular malformations,
bleomycin electrosclerotherapy,
bleomycin,
electrochemotherapy
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology,
Radiology

© 2023 Tobian Muir, Giulia Bertino, Ales Groselj, Lakshmi Ratnam, Erika Kis, Joy Odili, Ian McCafferty, Walter A Wohlgemuth, Maja Cemazar, Aljosa Krt, Masa Bosnjak, Alessandro Zanasi, Michela Battista, Francesca de Terlizzi, Luca G Campana, Gregor Sersa, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.

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