Annals of Surgical Oncology

, Volume 16, Issue 1, pp 191–199 | Cite as

Bleomycin-Based Electrochemotherapy: Clinical Outcome from a Single Institution’s Experience with 52 Patients

  • Luca G. Campana
  • Simone Mocellin
  • Michela Basso
  • Oliviero Puccetti
  • Gian Luca De Salvo
  • Vanna Chiarion-Sileni
  • Antonella Vecchiato
  • Luigi Corti
  • Carlo R. Rossi
  • Donato Nitti


Electrochemotherapy (ECT) has emerged as a complementary treatment for superficial metastases. Fifty-two consecutive patients with different cancer histotypes, mainly melanoma and breast cancer, with disease unsuitable for conventional treatments underwent bleomycin-based ECT for cutaneous and subcutaneous metastases. Toxicity, local response, response duration, and the impact on quality of life were evaluated. A total of 608 tumor nodules were treated (mean, 12 per patient), with 27% of patients affected by nodules >3 cm in size. Treatment was tolerated well, especially under general sedation. An objective response was obtained in 50 (96%) of 52 patients 1 month after the first application. Twenty-two patients underwent a second treatment (because of partial response or the appearance of new lesions). Partial response at first ECT achieved a response consolidation at second application: 80% complete response, 20% partial response. Some patients underwent up to five treatments because of new lesions, but maintained superficial tumor control. After a mean follow-up of 9 (range, 2–21) months, only two patients experienced relapse in the treatment field. Through a nonvalidated eight-item questionnaire (assessing wound healing and bleeding, aesthetic impairment, daily activities, social relations, pain, treatment satisfaction, acceptance of retreatment), most patients reported a benefit in local disease-related complaints and in activity of daily living. In a palliative setting, ECT proved to be safe, effective in all tumors treated, and useful in preserving patients’ quality of life. This benefit, although preliminary, deserves further assessment after a formal validation of the dedicated questionnaire.


Bleomycin Tumor Nodule Isolate Limb Perfusion Superficial Disease Eastern Cooperative Oncology Group Scale 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank the nursing staff members of CE.MU.R.N.I. (Centro Multidisciplinare Radiazioni Non Ionizzanti) and of the Melanoma Center at the Istituto Oncologico Veneto (IOV), Padova, for their assistance with patient care.


  1. 1.
    Chen C, Smye SW, Robinson MP, et al. Membrane electroporation theories: a review. Med Biol Eng Comput. 2006;44:5–14.CrossRefPubMedGoogle Scholar
  2. 2.
    Somiari S, Glasspool-Malone J, Drabick JJ, et al. Theory and in vivo application of electroporative gene delivery. Mol Ther. 2000;3:178–87.CrossRefGoogle Scholar
  3. 3.
    Heller R, Jaroszeski MJ, Atkin A, et al. In vivo gene electroinjection and expression in rat liver. FEBS Lett. 1996;389:225–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Cemazar M, Sersa G. Electrotransfer of therapeutic molecules into tissues. Curr Opin Mol Ther. 2007;9:554–62.PubMedGoogle Scholar
  5. 5.
    Mossop BJ, Barr RC, Henshaw W, et al. Electric fields in tumors exposed to external voltage sources: implication for electric field-mediated drug and gene delivery. Ann Biochem Eng. 2006;34:1564–72.CrossRefGoogle Scholar
  6. 6.
    Mir LM. Terapeutic perspectives of in vivo cell electropermeabilization. Bioelecrtochemistry. 2000;53:1–10.CrossRefGoogle Scholar
  7. 7.
    Belehradek M, Domenge C, Luboinski B, et al. Electrochemotherapy, a new antitumor treatment. First clinical phase I–II trial. Cancer. 1993;72:3694–700.CrossRefPubMedGoogle Scholar
  8. 8.
    Mir LM, Orlowski S. Mechanisms of electrochemotherapy. Adv Drug Del Rev. 1999;35:107–18.CrossRefGoogle Scholar
  9. 9.
    Gothelf A, Mir LM, Gehl J. Electrochemotherapy: results of cancer treatment using enhanced delivery of bleomycin by electroporation. Cancer Treat Rev. 2003;29:371–87.CrossRefPubMedGoogle Scholar
  10. 10.
    Serša G. The state-of-the-art of electrochemotherapy before the ESOPE study; advantages and clinical use. EJC Suppl. 2006;4:52–9.Google Scholar
  11. 11.
    Mir LM, Gehl J, Sersa G, 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 Cliniporator by means of invasive or non-invasive electrodes. EJC Suppl. 2006;4:14–25.CrossRefGoogle Scholar
  12. 12.
    Marty M, Serša G, Garbay JR, et al. Electrochemotherapy—An easy, highly effective and safe treatment of cutaneous and subcutaneous metastases: results of ESOPE study. EJC Suppl. 2006;4:3–13.CrossRefGoogle Scholar
  13. 13.
    Berle I. Clinical photography and patient rights: the need for orthopraxy. J Med Ethics. 2008;34:89–92.CrossRefPubMedGoogle Scholar
  14. 14.
    Therasse P, Arbuck SG, Eisenhauer EA. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.CrossRefPubMedGoogle Scholar
  15. 15.
    Rolz-Cruz G, Kim CC. Tumor invasion of the skin. Dermatol Clin. 2008;26:89–102.CrossRefPubMedGoogle Scholar
  16. 16.
    Rols MP, Bachaud JM, Giraud P, et al. Electrochemotherapy of cutaneous metastases in malignant melanoma. Melanoma Res. 2000;10:468–74.CrossRefPubMedGoogle Scholar
  17. 17.
    Giardino R, Fini M, Bonazzi V, et al. Electrochemotherapy a novel approach to the treatment of metastatic nodules on the skin and subcutaneous tissues. Biomed Pharmacol. 2006;60:458–62.CrossRefGoogle Scholar
  18. 18.
    Garbay JR, Billard V, Bernat C, et al. Successful repetitive treatments by Electrochemotherapy of multiple unresectable Kaposi sarcoma nodules. EJC Suppl. 2006;4:29–31.CrossRefGoogle Scholar
  19. 19.
    Whelan MC, Larkin JO, Collins CG, et al. Effective treatment of an extensive recurrent breast cancer which was refractory to multimodal therapy by multiple applications of Electrochemotherapy. EJC Suppl. 2006;4:32–4.CrossRefGoogle Scholar
  20. 20.
    Colombo GL, Di Matteo S, Mir LM. Cost-effectiveness of Electrochemotherapy with the Cliniporator vs other methods for the control and treatment of cutaneous and subcutaneous tumors. Ther Clin Risk Manag. 2008;4:1–8.Google Scholar
  21. 21.
    Mir LM, Glass LF, Sersa G, et al. Effective treatment of cutaneous and subcutaneous malignant tumours by electrochemotherapy. Br J Cancer. 1998;77:2336–42.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Byrne MC, Thompson JF, Johnston H, et al. Treatment of metastatic melanoma using electroporation therapy with bleomycin (electrochemotherapy). Melanoma Res. 2005;15:45–51.CrossRefPubMedGoogle Scholar
  23. 23.
    Gaudy C, Richard MA, Folchetti G, et al. Randomized controlled study of Electrochemotherapy in the local treatment of skin metastases of melanoma. J Cutan Med Surg. 2006, 10:115–21.CrossRefPubMedGoogle Scholar
  24. 24.
    Larkin JO, Collins CG, Aarons S, et al. Electrochemotherapy: aspects of preclinical development and early clinical experience. Ann Surg. 2007;245:469–79.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Quaglino P, Mortera C, Osella-Abate S, et al. Electrochemotherapy with intravenous bleomycin in the local treatment of skin melanoma metastases. Ann Surg Oncol. 2008;15:2215–22.CrossRefPubMedGoogle Scholar
  26. 26.
    Domenge C, Orlowski S, Luboinski B, et al. Antitumor electrochemotherapy: new advances in the clinical protocol. Cancer. 1996;77:956–63.CrossRefPubMedGoogle Scholar
  27. 27.
    Gilbert RA, Jaroszeski MJ, Heller R. Novel electrode designs for electrochemotherapy. Biochim Biophys Acta. 1997;1334:9–14.CrossRefPubMedGoogle Scholar
  28. 28.
    Heller L, Pottinger C, Jaroszeski MJ, et al. In vivo electroporation of plasmids encoding GM-CSF or interleukin-2 into existing B16 melanomas combined with electrochemotherapy induces long-term antitumour immunità. Melanoma Res. 2000;10:577–83.CrossRefPubMedGoogle Scholar
  29. 29.
    Roux S, Bernat C, Al-Sakere B, et al. Tumor destruction using electrochemotherapy followed by CpG oligodeoxynucleotide injection induces distant tumor responses. Cancer Immunol Immunother. 2008;57:1291–300.CrossRefPubMedGoogle Scholar
  30. 30.
    Serša G, Kranjc S, Čemažar M, et al. Improvement of combined modality therapy with cisplatin and radiation using electroporation of tumors. Int J Radiat Oncol Biol Phys. 2000;46:1037–41.CrossRefPubMedGoogle Scholar
  31. 31.
    Serša G, Štabuc B, Čemažar M, et al. Electrochemotherapy with cisplatin: the systemic antitumor effectiveness of cisplatin can be potentiated locally by the application of electric pulses in the treatment of malignant melanoma skin metastases. Melanoma Res. 2000, 10:381–5.CrossRefPubMedGoogle Scholar
  32. 32.
    Zitvogel L, Apetoh L, Ghiringhelli F, et al. Immunological aspects of cancer chemotherapy. Nat Rev Immunol. 2008;8:59–73.CrossRefPubMedGoogle Scholar
  33. 33.
    Wagner LI, Wenzel L, Shaw E, et al. Patient-reported outcomes in Phase II cancer clinical trials: lesson learned and future directions. J Clin Oncol. 2007;25:5058–62.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2008

Authors and Affiliations

  • Luca G. Campana
    • 1
  • Simone Mocellin
    • 1
  • Michela Basso
    • 2
  • Oliviero Puccetti
    • 3
  • Gian Luca De Salvo
    • 2
  • Vanna Chiarion-Sileni
    • 2
  • Antonella Vecchiato
    • 2
  • Luigi Corti
    • 2
  • Carlo R. Rossi
    • 1
  • Donato Nitti
    • 1
  1. 1.Department of Oncological and Surgical SciencesIstituto di Clinica Chirurgica Generale IIPadovaItaly
  2. 2.Istituto Oncologico VenetoPadovaItaly
  3. 3.Oncologia Medica, ThieneVicenzaItaly

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