Sarcoma and Melanoma Unit, Veneto Institute of Oncology (IOV-IRCCS), Via Gattamelata, 64, 35128, Padua, Italy,
J Cancer Res Clin Oncol. 2014 Sep;140(9):1557-65. doi: 10.1007/s00432-014-1691-6. Epub 2014 May 3.
To evaluate the efficacy and toxicity of electrochemotherapy (ECT) in elderly metastatic breast cancer (BC) patients.
Retrospective analysis of 55 patients with superficial metastases who underwent ECT according to the European Standard Operative Procedures of electrochemotherapy. Treatment schedule consisted of intravenous or intratumoral bleomycin followed by locally delivered electric pulses. Statistical comparisons were performed between two groups: the patients aged <70 years (n = 27) and those ≥70 years (n = 28). Treatment outcomes were as follows: complete response (CR) rate, local progression-free survival (LPFS), new lesions-free survival (NLFS), toxicity and patient compliance.
Patient groups were comparable for clinical-pathological features, except for the number of comorbidities (P < .001). The median follow-up was 32 months (range 6-53). Overall, CR rate was 40 % and was significantly higher in elderly patients (57 vs. 26 %, P = .023) and in patients with better performance status (PS = 0-1, 53 vs. PS = 2, 21 %, P = .048), although local tumor control showed a trend for lower values (2-year LPFS, 67 vs. 93 % among elderly and young patients, respectively; P = .061). Older women seemed less likely to progress outside the ECT field (2-year NLFS, 39 vs. 30 %, P = .075), but discontinued treatment more frequently due to impaired performance status (P = .002). Local pain was graded ≥3, according to a 10-point visual analog scale, by 16/28 (57.1 %) and 8/28 (28.6 %) elderly patients at 4 and 8 weeks, respectively. Wound debridement was required in 5/28 (18 %) older women, due to G3 skin ulceration.
Elderly BC patients are highly responsive to ECT and achieve durable local tumor control. Physicians should be aware of possible debilitating side effects, such as pain and skin toxicity. Performance status and frailty screening could be a helpful addition to improve patient selection.
评估电化学疗法（ECT）在老年转移性乳腺癌（BC）患者中的疗效和毒性。
对 55 例根据欧洲电化学疗法标准操作规程接受 ECT 的浅表转移性患者进行回顾性分析。治疗方案包括静脉内或肿瘤内博来霉素，然后局部给予电脉冲。在两组患者之间进行了统计学比较：年龄<70 岁（n=27）和年龄≥70 岁（n=28）的患者。治疗结果如下：完全缓解（CR）率、局部无进展生存期（LPFS）、无新病变生存期（NLFS）、毒性和患者依从性。
患者组在临床病理特征方面具有可比性，但合并症数量除外（P<0.001）。中位随访时间为 32 个月（范围 6-53）。总体而言，CR 率为 40%，老年患者明显更高（57%比 26%，P=0.023），且表现状态（PS）更好的患者（PS=0-1，53%比 PS=2，21%，P=0.048）也更高，尽管局部肿瘤控制值呈下降趋势（2 年 LPFS，老年和年轻患者分别为 67%和 93%；P=0.061）。老年女性在 ECT 区域外进展的可能性似乎较低（2 年 NLFS，分别为 39%和 30%；P=0.075），但由于表现状态受损，她们更频繁地停止治疗（P=0.002）。根据 10 分视觉模拟量表，16/28（57.1%）和 8/28（28.6%）名老年患者在 4 周和 8 周时分别出现≥3 级的局部疼痛。由于 3 级皮肤溃疡，5/28（18%）名老年女性需要进行伤口清创。
老年 BC 患者对 ECT 反应良好，可获得持久的局部肿瘤控制。医生应注意可能导致衰弱的副作用，如疼痛和皮肤毒性。表现状态和脆弱性筛查可能有助于改善患者选择。
