肢体移行性黑素瘤的电化学疗法治疗策略：一项欧洲回顾性队列研究的真实世界结果
Treatment strategies with electrochemotherapy for limb in-transit melanoma: Real-world outcomes from a European, retrospective, cohort study.
作者信息
Campana Luca G, Tauceri Francesca, Bártolo Joana, Calabrese Sarah, Odili Joy, Carrara Giulia, Farricha Victor, Piazzalunga Dario, Bottyán Kriszta, Bisarya Kamal, Mascherini Matteo, Clover James A, Sestini Serena, Bošnjak Maša, Kis Erika, Fantini Fabrizio, Covarelli Piero, Brizio Matteo, Sayed Leela, Cabula Carlo, Careri Rosanna, Fabrizio Tommaso, Eisendle Klaus, MacKenzie Ross Alastair, Schepler Hadrian, Borgognoni Lorenzo, Sersa Gregor, Valpione Sara
机构信息
Department of Surgery, Manchester University NHS Foundation Trust, Manchester, UK; Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy.
General and Oncological Surgery Unit, Morgagni-Pierantoni Hospital, Forli, Italy.
出版信息
Eur J Surg Oncol. 2025 Aug;51(8):108740. doi: 10.1016/j.ejso.2024.108740. Epub 2024 Oct 5.
BACKGROUND
This study analysed treatment strategies with electrochemotherapy (ECT) in melanoma with limb in-transit metastases (ITM).
METHODS
We audited AJCC v.8 stage IIIB-IIID patients treated across 22 centres (2006-2020) within the International Network for Sharing Practices of ECT (InspECT).
RESULTS
452 patients were included, 58 % pre-treated (93 % had lower limb ITM, 44 % had ≤10 metastases [median size 1.5 cm]. Treatment strategies included first-line ECT (n = 145, 32 %), ECT with concurrent locoregional/systemic treatment (n = 163, 36 %), and salvage ECT (n = 144, 32 %). The objective response rate was 63 % (complete response [CR], 24 %), increasing to 74 % (CR, 39 %) following retreatment (median two ECT, range 1-8). CR rate in treatment-naïve and pre-treated patients was 50 % vs 32 % (p < 0.001). Bleomycin de-escalation was associated with lower CR (p = 0.004). Small tumour number and size, hexagonal electrode, retreatment, and post-ECT skin ulceration predicted response in multivariable analysis. At a median follow-up of 61 months, local and locoregional recurrence occurred in 55 % and 81 % of patients. Median local progression-free, new lesions-free, and regional recurrence-free survival were 32.9, 6.9, and 7.7 months. Grade-3 toxicity was 15 %. Concurrent treatment and CR correlated with improved regional control and survival. Concomitant checkpoint inhibition did not impact toxicity or survival outcomes. The median overall survival was 5.7 years.
CONCLUSIONS
Among patients with low-burden limb-only ITM, standard-dose bleomycin ECT results in durable local response. Treatment naivety, low tumour volume, hexagonal electrode application, retreatment, and post-ECT ulceration predict response. CR and concurrent treatment correlate with improved regional control and survival outcomes. Combination with checkpoint inhibitors is safe but lacks conclusive support.
背景
本研究分析了电化学疗法（ECT）治疗伴有肢体移行转移（ITM）的黑色素瘤的治疗策略。
方法
我们审核了国际ECT实践分享网络（InspECT）中22个中心（2006 - 2020年）治疗的美国癌症联合委员会（AJCC）第8版IIIB - IIID期患者。
结果
纳入452例患者，58%曾接受过治疗（93%有下肢ITM，44%有≤10个转移灶[中位大小1.5厘米]）。治疗策略包括一线ECT（n = 145，32%）、ECT联合局部/全身同期治疗（n = 163，36%）和挽救性ECT（n = 144，32%）。客观缓解率为63%（完全缓解[CR]，24%），再次治疗后（中位两次ECT，范围1 - 8次）增至74%（CR，39%）。初治患者和曾接受过治疗的患者的CR率分别为50%和32%（p < 0.001）。博来霉素剂量降低与较低的CR相关（p = 0.004）。在多变量分析中，肿瘤数量和大小少、使用六边形电极、再次治疗以及ECT后皮肤溃疡可预测缓解情况。中位随访61个月时，55%和81%的患者出现局部和局部区域复发。局部无进展生存期、无新病灶生存期和区域无复发生存期的中位数分别为32.9、6.9和7.7个月。3级毒性为15%。同期治疗和CR与改善区域控制和生存相关。同时使用检查点抑制剂对毒性或生存结果无影响。总生存期的中位数为5.7年。
结论
在仅伴有低负荷肢体ITM的患者中，标准剂量博来霉素ECT可产生持久的局部缓解。初治、肿瘤体积小、应用六边形电极、再次治疗以及ECT后溃疡可预测缓解情况。CR和同期治疗与改善区域控制和生存结果相关。与检查点抑制剂联合使用是安全的，但缺乏确凿支持。
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