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

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

Radiology and Oncology
Volume 59 (2025): Issue 2 (June 2025)
By: Ales Groselj,  Giulia Bertino,  Marta Minuti,  Anthony James P Clover,  Camilla Kjaer Lonkvist,  Erika Kis,  Christian Kunte,  Tobian Muir,  Francesco Russano,  Francesca de Terlizzi,  Joy Odili and  Gregor Sersa  
Open Access
|Jun 2025

Figures & Tables

FIGURE 1.

Types of electrodes used. (A) Type I: two plates with a 6 mm gap; (B) type IV: a wearable finger electrode with two parallel rows of needles; (C) type III: a hexagonal array with a 7.3 mm gap; or (D) type II: two parallel rows of needles with a 4 mm gap.
Types of electrodes used. (A) Type I: two plates with a 6 mm gap; (B) type IV: a wearable finger electrode with two parallel rows of needles; (C) type III: a hexagonal array with a 7.3 mm gap; or (D) type II: two parallel rows of needles with a 4 mm gap.

FIGURE 2.

Disease-free survival (DFS) of nodules treated with local (intratumoral, IT) or systemic (intravenous, IV) drug administration. YRS = years
Disease-free survival (DFS) of nodules treated with local (intratumoral, IT) or systemic (intravenous, IV) drug administration. YRS = years

FIGURE 3.

Treatment outcomes of patients treated with intravenous and intratumoral electrochemotherapy (ECT). The outcome is good in larger and smaller basal cell carcinoma (BCC) tumors. Patient No.1 (A) Recurrent BCC after multiple surgeries in a male, 82 years old patient. ECT performed under sedation and local anesthesia. Intravenous bleomycin 18200 IU. Needle row electrode; 11 pulses. Three cycles of ECT were performed (2 for the first treatment; 1 for recurrence after 2 years). (B) Result after 5 years of follow-up. Patient No. 2 (C) Primary BCC in a female, 86 years old patient with multiple severe comorbidities and non-suitable to standard treatments. One ECT session was performed under sedation and local anesthesia. Intralesional Bleomycin 1.5 ml (concentration 1 mg/ml). Needle row electrode; 7 pulses. (D) Result after 5 years of follow-up. Patient No. 3 (E) Primary BCC in a female, 69 years old patient. Patient refused standard treatments. One ECT session was performed in general anesthesia with laryngeal mask. Intravenous bleomycin 18200 IU; Hexagonal electrode; 9 pulses. (F) Result after 5 years of follow-up. Patient No.4 (G) Primary BCC in a female, 88 years old patient with severe comorbidities, Alzheimer’s disease and non-suitable to standard treatments. One ECT session was performed in general anesthesia with laryngeal mask. Intralesional bleomycin 1.5 ml (concentration 1 mg/ml); Finger electrode; 10 pulses. (H) Result after 5 years of follow-up.
Treatment outcomes of patients treated with intravenous and intratumoral electrochemotherapy (ECT). The outcome is good in larger and smaller basal cell carcinoma (BCC) tumors. Patient No.1 (A) Recurrent BCC after multiple surgeries in a male, 82 years old patient. ECT performed under sedation and local anesthesia. Intravenous bleomycin 18200 IU. Needle row electrode; 11 pulses. Three cycles of ECT were performed (2 for the first treatment; 1 for recurrence after 2 years). (B) Result after 5 years of follow-up. Patient No. 2 (C) Primary BCC in a female, 86 years old patient with multiple severe comorbidities and non-suitable to standard treatments. One ECT session was performed under sedation and local anesthesia. Intralesional Bleomycin 1.5 ml (concentration 1 mg/ml). Needle row electrode; 7 pulses. (D) Result after 5 years of follow-up. Patient No. 3 (E) Primary BCC in a female, 69 years old patient. Patient refused standard treatments. One ECT session was performed in general anesthesia with laryngeal mask. Intravenous bleomycin 18200 IU; Hexagonal electrode; 9 pulses. (F) Result after 5 years of follow-up. Patient No.4 (G) Primary BCC in a female, 88 years old patient with severe comorbidities, Alzheimer’s disease and non-suitable to standard treatments. One ECT session was performed in general anesthesia with laryngeal mask. Intralesional bleomycin 1.5 ml (concentration 1 mg/ml); Finger electrode; 10 pulses. (H) Result after 5 years of follow-up.

FIGURE 4.

Pain intensity (visual numeric scale, VNS) preelectrochemotherapy (pre-ECT), immediately post-ECT and 1 month after ECT (mean and standard error).
Pain intensity (visual numeric scale, VNS) preelectrochemotherapy (pre-ECT), immediately post-ECT and 1 month after ECT (mean and standard error).

FIGURE 5.

Kaplan-Meier survival curves for the whole population. DFS = disease free survival
Kaplan-Meier survival curves for the whole population. DFS = disease free survival

FIGURE 6.

Kaplan-Meier survival (A) of patients with small (< 3 cm) vs large (> 3 cm) lesions (B), patients with primary vs recurrent lesions (C), patients with single vs multiple lesions (D), and patients with ulcerated vs nonulcerated lesions. The differences were not significant. DFS = disease free survival; YRS = years
Kaplan-Meier survival (A) of patients with small (< 3 cm) vs large (> 3 cm) lesions (B), patients with primary vs recurrent lesions (C), patients with single vs multiple lesions (D), and patients with ulcerated vs nonulcerated lesions. The differences were not significant. DFS = disease free survival; YRS = years

Distribution of patients according to drug delivery and type of anesthesia

Local drug (IT)Systemic drug (IV)
Local anesthesia4753
General anesthesia923

Characteristics of the recurrent patients

PtAgePrimaryPrevious therapyLocalizationSize (cm)Time recurrence (years)Treatment of the recurrenceStatus at 5 years of follow-up
182RecurrentSurgeryNasal ala2.52.9ECTNED
260PrimaryNoTemporal region1.84.1SurgeryNED
389RecurrentNoNasal ala1.74.7NoAWD
484RecurrentNoNasolabial fold3.04.7RTAWD
568PrimarySurgeryTip of the nose1.04.5ECTNED
674RecurrentSurgeryNasolabial fold1.64.2NoAWD
772RecurrentSurgery +RTScalp1.54.2SurgeryNED

Descriptive characteristics of the population

N%
GENDER
 Males8061%
 Female5239%
LESIONS’ NUMEROSITY
 Single10277%
 Multiple3023%
T STAGE
 T19975%
 T2118%
 T311%
 Tis2116%
TYPE OF TUMOR
 Primary7255%
 Recurrent6045%
ULCERATED
 No9673%
 Yes3627%
LESIONS’ PREIRRADIATION
 Yes32%
PREVIOUS TREATMENTS
 Surgery5239%
 Radiotherapy22%
 Surgery, radiotherapy65%
 Surgery, other therapies11%
 Surgery, radiotherapy, other therapies22%
 No6951%

Symptoms and side effects per patient: comparison between pre-ECT values and 1-month post-ECT values

Pre-ECT1-month post-ECT
Nausea1 (1%)0 (0%)
Flu0 (0%)0 (0%)
Suppuration1 (1%)2 (1%)
Hyperpigmentation1 (1%)10 (8%)
Ulceration36 (27%)14 (11%)
Crust0 (0%)2 (1%)
Edema/rush0 (0%)3 (2%)

Locations of nodules

LOCALIZATIONN%
Nose6541%
Ear2012%
Forehead/temple1610%
Eye1610%
Cheek64%
Scalp53%
Lip43%
Chin32%
Neck11%
Other locations2214%

Characteristics of the patients who experienced recurrence during the first year of follow-up

PtAgePrimaryPrevious therapyLocalizationSize (cm)Time recurrence (months)Treatment of the recurrenceStatus at 5 years of follow-up
152RecurrentSurgeryNasal ala1.27ECTNED
273PrimaryNoTemporal region1.510SurgeryNED
365RecurrentSurgeryEar1.811ECT, surgeryNED
452PrimaryNoMultiple (face)3.011ECTNED
DOI: https://doi.org/10.2478/raon-2025-0040 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Journal RSS Feed
Language: English
Page range: 233 - 243
Submitted on: Apr 10, 2025
|
Accepted on: Apr 18, 2025
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Published on: Jun 21, 2025
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
basal cell carcinoma,
electrochemotherapy,
recurrence free survival,
5 years
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology,
Radiology

© 2025 Ales Groselj, Giulia Bertino, Marta Minuti, Anthony James P Clover, Camilla Kjaer Lonkvist, Erika Kis, Christian Kunte, Tobian Muir, Francesco Russano, Francesca de Terlizzi, Joy Odili, 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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