Electrochemotherapy for basal cell carcinoma in the head and neck region: 5-year follow-up from the Insp-ECT registry

Groselj, Ales; Bertino, Giulia; Minuti, Marta; Clover, Anthony James P; Lonkvist, Camilla Kjaer; Kis, Erika; Kunte, Christian; Muir, Tobian; Russano, Francesco; Terlizzi, Francesca de; Odili, Joy; Sersa, Gregor

doi:10.2478/raon-2025-0040

Abstract

Background

Basal cell carcinoma (BCC) is a cutaneous malignancy that typically appears in sun-exposed areas. We analyzed data from the Insp-ECT registry of all patients affected by BCC in the head and neck region. The aim of this study was to evaluate the safety and efficacy of electrochemotherapy (ECT) on a 5-year basis.

Patients and methods

A cohort of 132 patients was included. They were treated by ECT according to the current Standard Operating Procedures. The median age was 74 years (range 41–93). There was a median of 1 nodule per patient (range 1–7), and the median size of the lesions was 1.4 cm (range 0.5–5.0 cm).

Results

Patients tolerated ECT well, and 96% agreed to repeat it if needed. The side effects were mild and temporary. All patients achieved a complete clinical response after 1 to 3 ECT sessions. During the first year of follow-up, 4 (3%) patients experienced recurrence, which was treated (2 with ECT, 1 with surgery, and 1 with a combination of ECT and surgery), after which they remained free of disease until the end of follow-up at 5 years. Five patients reported recurrence thereafter and were treated according to their condition. At the 5-year follow-up, the disease-free survival (DFS) rate was 92% (95% confidence interval [CI]: 87%–96%). At that time, 3 patients were alive with disease (2%), and 124 patients were free of disease (98%).

Conclusions

This study shows the feasibility and efficacy of ECT treatment in elderly patients with BCC tumors in aesthetically and functionally sensitive areas, with negligible toxicity. Comparable efficacy to other treatment modalities was demonstrated at 1 year and 5 years of follow-up in terms of DFS.

References

Levell NJ, Igali L, Wright KA, Greenberg DC. Basal cell carcinoma epidemiology in the UK: the elephant in the room. Clin Exp Dermatol 2013; 38: 367-9. doi: 10.1111/ced.12016
Open DOI Search in Google Scholar Back to article
Heath MS, Bar A. Basal cell carcinoma. Dermatol Clin 2023; 41: 13-21. doi: 10.1016/j.det.2022.07.005
Open DOI Search in Google Scholar Back to article
Gordon R. Skin cancer: an overview of epidemiology and risk factors. Sem Oncol Nursing 2013; 29: 160-9. doi: 10.1016/j.soncn.2013.06.002
Open DOI Search in Google Scholar Back to article
Kim JYS, Kozlow JH, Mittal B, Kozlow JH, Mittal B, Moyer J, et al. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol 2018; 78: 540-59. doi: 10.1016/j.jaad.2017.10.006
Open DOI Search in Google Scholar Back to article
Cameron MC, Lee E, Hibler BP, Barker CA, Mori S, Cordova M, et al. Basal cell carcinoma. J Am Acad Dermatol 2019; 80: 321-39. doi: 10.1016/j.jaad.2018.02.083
Open DOI Search in Google Scholar Back to article
Peris K, Fargnoli MC, Kaufmann R, Arenberger P, Bastholt L, Seguin NB, et al. European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma – update 2023. Eur J Cancer 2023; 192: 113254. doi: 10.1016/j.ejca.2023.113254
Open DOI Search in Google Scholar Back to article
Lyons P, Kennedy A, Clover AJP. Electrochemotherapy and basal cell carcinomas: first-time appraisal of the efficacy of electrochemotherapy on survivorship using FACE-Q. JPRAS Open 2021; 27: 119-28. doi: 10.1016/j.jpra.2020.12.004
Open DOI Search in Google Scholar Back to article
Russano F, Brugnolo D, Bisetto G, Del Fiore P, Rastrelli M, Mocellin S, et al. Electrochemotherapy treatment in a patient with an extended basal cell carcinoma of the face: a case report. JPM 2024; 14: 984. doi: 10.3390/jpm14090984
Open DOI Search in Google Scholar Back to article
Carpenè S, Silvestri B, Bertinazzi M, Armato E, Amadori M, Spinato R, et al. Electrochemotherapy as adjuvant treatment in a sinonasal mucosal melanoma in elderly patient: a case report. Eur Arch Otorhinolaryngol 2024; 281: 3853-8. doi: 10.1007/s00405-024-08606-z
Open DOI Search in Google Scholar Back to article
Sersa G, Mascherini M, Di Prata C, Odili J, de Terlizzi F, McKenzie GAG, et al. Outcomes of older adults aged 90 and over with cutaneous malignancies after electrochemotherapy with bleomycin: a matched cohort analysis from the InspECT registry. Eur J Surg Oncol 2021; 47: 902-12. doi: 10.1016/j.ejso.2020.10.037
Open DOI Search in Google Scholar Back to article
Mir LM, Glass LF, Sersa G, Teissié J, Domenge C, Miklavcic D, et al. Effective treatment of cutaneous and subcutaneous malignant tumours by electrochemotherapy. Br J Cancer 1998; 77: 2336–42. doi: 10.1038/bjc.1998.388
Open DOI Search in Google Scholar Back to article
Clover AJP, Salwa SP, Bourke MG, McKiernan J, Forde PF, O’Sullivan ST, et al. Electrochemotherapy for the treatment of primary basal cell carcinoma; a randomised control trial comparing electrochemotherapy and surgery with five year follow up. Eur J Surg Oncol 2020; 46: 847-54. doi: 10.1016/j.ejso.2019.11.509
Open DOI Search in Google Scholar Back to article
Clover AJP, de Terlizzi F, Bertino G, Curatolo P, Odili J, Campana LG, et al. Electrochemotherapy in the treatment of cutaneous malignancy: outcomes and subgroup analysis from the cumulative results from the pan-European International Network for Sharing Practice in Electrochemotherapy database for 2482 lesions in 987 patients (2008–2019). Eur J Cancer 2020; 138: 30-40. doi: 10.1016/j.ejca.2020.06.020
Open DOI Search in Google Scholar Back to article
Bertino G, Sersa G, De Terlizzi F, Occhini A, Plaschke CC, Groselj A, et al. European Research on Electrochemotherapy in Head and Neck Cancer (EURECA) project: results of the treatment of skin cancer. Eur J Cancer 2016; 63: 41-52. doi: 10.1016/j.ejca.2016.05.001
Open DOI Search in Google Scholar Back to article
Bertino G, Muir T, Odili J, Groselj A, Marconato R, Curatolo P, et al; the InspECT BCC Working Group. Treatment of basal cell carcinoma with electrochemotherapy: insights from the InspECT Registry (2008–2019). Curr Oncol 2022; 29: 5324-37. doi: 10.3390/curroncol29080423
Open DOI Search in Google Scholar Back to article
Sersa G, Miklavcic D, Cemazar M, Rudolf Z, Pucihar G, Snoj M. Electrochemotherapy in treatment of tumours. Eur J Surg Oncol 2008; 34: 232-40. doi: 10.1016/j.ejso.2007.05.016
Open DOI Search in Google Scholar Back to article
Marty M, Sersa G, Garbay JR, Gehl J, Collins CG, Snoj M, et al. Electrochemotherapy – an easy, highly effective and safe treatment of cutaneous and subcutaneous metastases: results of ESOPE (European Standard Operating Procedures of Electrochemotherapy) study. Eur J Cancer Suppl 2006; 4: 3-13. doi: 10.1016/j.ejcsup.2006.08.002
Open DOI Search in Google Scholar Back to article
Plaschke CC, Bertino G, McCaul JA, Grau JJ, de Bree R, Sersa G, et al. European Research on Electrochemotherapy in Head and Neck Cancer (EURECA) project: results from the treatment of mucosal cancers. Eur J Cancer 2017; 87: 172-81. doi: 10.1016/j.ejca.2017.10.008
Open DOI Search in Google Scholar Back to article
Sersa G, Ursic K, Cemazar M, Heller R, Bosnjak M, Campana LG. Biological factors of the tumour response to electrochemotherapy: review of the evidence and a research roadmap. Eur J Surg Oncol 2021: 47: 1836-46. doi: 10.1016/j.ejso.2021.03.229
Open DOI Search in Google Scholar Back to article
Sersa G, Jarm T, Kotnik T, Coer A, Podkrajsek M, Sentjurc M, et al. Vascular disrupting action of electroporation and electrochemotherapy with bleomycin in murine sarcoma. Br J Cancer 2008; 98: 388-98. doi: 10.1038/sj.bjc.6604168
Open DOI Search in Google Scholar Back to article
Jarm T, Cemazar M, Miklavcic D, Sersa G. Antivascular effects of electrochemotherapy: implications in treatment of bleeding metastases. Expert Rev Anticancer Ther 2010; 10: 729-46. doi: 10.1586/era.10.43
Open DOI Search in Google Scholar Back to article
Mir LM, Gehl J, Sersa G, Collins CG, Garbay JR, Billard V, et al. Standard operating procedures of the electrochemotherapy: Instructions for the use of bleomycin or cisplatin administered either systemically or locally and electric pulses delivered by the CliniporatorTM by means of invasive or non-invasive electrodes. Eur J Cancer Suppl 2006; 4: 14-25. doi: 10.1016/j.ejcsup.2006.08.003
Open DOI Search in Google Scholar Back to article
Gehl J, Sersa G, Matthiessen LW, Muir T, Soden D, Occhini A, et al. Updated standard operating procedures for electrochemotherapy of cutaneous tumours and skin metastases. Acta Oncol 2018; 57: 874-82. doi: 10.1080/0284186X.2018.1454602
Open DOI Search in Google Scholar Back to article
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: Revised RECIST Guideline (version 1.1). Eur J Cancer 2009; 45: 228-47. doi: 10.1016/j.ejca.2008.10.026
Open DOI Search in Google Scholar Back to article
Bertino G, Groselj A, Campana LG, Kunte C, Schepler H, Gehl J, et al. Electrochemotherapy for the treatment of cutaneous squamous cell carcinoma: the INSPECT experience (2008-2020). Front Oncol 2022; 12: 951662. doi: 10.3389/fonc.2022.951662
Open DOI Search in Google Scholar Back to article
Peris K, Fargnoli MC, Garbe C, Kaufmann R, Bastholt L, Seguin NB, et al. Diagnosis and treatment of basal cell carcinoma: European consensusbased interdisciplinary guidelines. Eur J Cancer 2019; 118: 10-34. doi: 10.1016/j.ejca.2019.06.003
Open DOI Search in Google Scholar Back to article
Strom TJ, Caudell JJ, Harrison LB. Management of BCC and SCC of the head and neck. Cancer Control 2016; 23: 220-7. doi: 10.1177/107327481602300305
Open DOI Search in Google Scholar Back to article
Justesen TF, Orhan A, Raskov H, Nolsoe C, Gögenur I. Electroporation and immunotherapy – unleashing the abscopal effect. Cancers 2022; 14: 2876. doi: 10.3390/cancers14122876
Open DOI Search in Google Scholar Back to article
Ferioli M, Perrone AM, De Iaco P, Zamfir AA, Ravegnini G, Buwenge M, et al. Clinical insights and future prospects: a comprehensive narrative review on immunomodulation induced by electrochemotherapy. Current Oncol 2024; 31: 6433-64. doi: 10.3390/curroncol31100478
Open DOI Search in Google Scholar Back to article
Jayaraman SS, Rayhan DJ, Hazany S, Kolodney MS. Mutational landscape of basal cell carcinomas by whole-exome sequencing. J Invest Dermatol 2014; 134: 213-20. doi: 10.1038/jid.2013.276
Open DOI Search in Google Scholar Back to article
Groselj A, Kranjc S, Bosnjak M, Krzan M, Kosjek T, Prevc A, et al. Vascularization of the tumours affects the pharmacokinetics of bleomycin and the effectiveness of electrochemotherapy. Basic Clin Pharmacol Toxicol 2018; 123: 247-56. doi: 10.1111/bcpt.13012
Open DOI Search in Google Scholar Back to article
Jamsek C, Sersa G, Bosnjak M, Groselj A. Long term response of electrochemotherapy with reduced dose of bleomycin in elderly patients with head and neck non-melanoma skin cancer. Radiol Oncol 2020; 54: 79-85. doi: 10.2478/raon-2020-0009
Open DOI Search in Google Scholar Back to article
Andersen YMF, Karmisholt K, Høgsberg T, Nielsen ML, Brosbøl A, Stave S, et al. 10 years of Mohs micrographic surgery in Denmark: results from a nationwide cohort. Acta Derm Venereol 2025; 105: adv41118. doi: 10.2340/actadv.v105.41118
Open DOI Search in Google Scholar Back to article