Annals of Surgical Oncology

, Volume 19, Issue 1, pp 192–198 | Cite as

Electrochemotherapy in the Treatment of Kaposi Sarcoma Cutaneous Lesions: A Two-Center Prospective Phase II Trial

  • Pietro Curatolo
  • Pietro QuaglinoEmail author
  • Federica Marenco
  • Monica Mancini
  • Tiziana Nardò
  • Claudio Mortera
  • Roberta Rotunno
  • Stefano Calvieri
  • Maria Grazia Bernengo
Bone and Soft Tissue Sarcomas



Electrochemotherapy (ECT) is an emerging treatment for cutaneous lesions of different tumor types. The combination of chemotherapy and electroporation enhances drug uptake into tumoral cells. However, its role in the treatment of Kaposi sarcoma (KS) has not yet been well defined, and to date, literature reports are scarce. We prospectively evaluated clinical activity and safety of ECT in KS patients.


Twenty-three patients with histologically confirmed unresectable KS, not treatable by radiotherapy or intralesional vincristine therapy, were enrolled onto the study according to the European Standard Operating Procedures of Electrochemotherapy (ESOPE) guidelines and treated with a pulse generator.


A response to the first ECT session was obtained in all patients, with a complete response (CR) in 14 (60.9%) of 23 patients. A second ECT was performed in 5 (21.7%) and a third in 2, with a median interval between two sessions of 5.1 (range 2.5–25.5) months. Overall, a total of 15 patients (65%) experienced a CR. After a median follow-up of 1.5 years (range 2 months to 4.2 years), 16 patients maintained the response, 4 after repeated courses. Sustained local control of treated lesions was present in 20 of 23 patients. The overall survival rate was 74.4% at 2 years.


ECT represents an additional therapeutic tool for the management of KS cutaneous lesions, characterized by a definite clinical activity and long-lasting remissions. The absence of systemic side effects and the low impact on the immune system also make this treatment suitable for elderly people, even with repeated courses.


Bleomycin Liposomal Doxorubicin Local Tumor Control Patient Global Assessment Dermatologic Clinic 
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.


  1. 1.
    Kaposi M. Idiopathisches multiples Pigmentsarkom der Haut. Arch Dermatol Syphilis. 1872;4:265–73.CrossRefGoogle Scholar
  2. 2.
    Iscovich J, Boffetta P, Franceschi S, Azizi E, Sarid R. Classic kaposi sarcoma: epidemiology and risk factors. Cancer. 2000;88:500–17.PubMedCrossRefGoogle Scholar
  3. 3.
    Toschi E, Sgadari C, Monini P, et al. Treatment of Kaposi sarcoma-an update. Anticancer Drugs. 2002;13:977–87.PubMedCrossRefGoogle Scholar
  4. 4.
    Schwartz RA. Kaposi’s sarcoma: an update. J Surg Oncol. 2004;87:146–51.PubMedCrossRefGoogle Scholar
  5. 5.
    Symmers D. Kaposi’s disease. Arch Pathol. 1941;32:764–86.Google Scholar
  6. 6.
    Di Lorenzo G, Konstantinopoulos PA, Pantanowitz L, Di Trolio R, De Placido S, Dezube BJ. Management of AIDS-related Kaposi’s sarcoma. Lancet Oncol. 2007;8:167–76.PubMedCrossRefGoogle Scholar
  7. 7.
    Schwartz RA. Kaposi’s sarcoma: advances and perspectives. J Am Acad Dermatol. 1996;34:804–14.PubMedCrossRefGoogle Scholar
  8. 8.
    Giardino R, Fini M, Bonazzi V, Cadossi R, Nicolini A, Carpi A. Electrochemotherapy: a novel approach to the treatment of metastatic nodules on the skin and subcutaneous tissues. Biomed Pharmacother. 2006;60:458–62.PubMedCrossRefGoogle Scholar
  9. 9.
    Miklavcic D, Snoj M, Zupanic A, et al. Towards treatment planning and treatment of deep-seated solid tumors by electrochemotherapy. Biomed Eng Online. 2010;9:10.PubMedCrossRefGoogle Scholar
  10. 10.
    Marty M, Sersa G, Garbay JR, 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.CrossRefGoogle 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. Eur J Cancer Suppl. 2006;4:14–25.CrossRefGoogle Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    Heller R, Jaroszeski MJ, Reintgen DS, et al. Treatment of cutaneous and subcutaneous tumors with electrochemotherapy using intralesional bleomycin. Cancer. 1998;83:148–57.PubMedCrossRefGoogle Scholar
  14. 14.
    Curatolo P, Mancini M, Ruggiero A, Clerico R, Di Marco P, Calvieri S. Successful treatment of penile Kaposi’s sarcoma with electrochemotherapy. Dermatol Surg. 2008;34:839–42.PubMedCrossRefGoogle Scholar
  15. 15.
    Gualdi G, Monari P, Fantini F, Cesinaro AM, Cimitan A. Electrochemotherapy-induced virus disappearance in HHV-8-positive skin nodules of Kaposi sarcoma: first histological and immunohistochemical demonstration of efficacy. J Eur Acad Dermatol Venereol. 2010;24:239–41.PubMedCrossRefGoogle Scholar
  16. 16.
    Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst. 2000;92:205–16.PubMedCrossRefGoogle Scholar
  17. 17.
    Pincus T, Bergman M, Sokka T, Roth J, Swearingen C, Yazici Y. Visual analog scales in formats other than a 10 centimeter horizontal line to assess pain and other clinical data. J Rheumatol. 2008;35:1550–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Hamilton CR, Cummings BJ, Harwood AR. Radiotherapy of Kaposi’s sarcoma. Int J Radiat Oncol Biol Phys. 1986;12:1931–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Lo TC, Salzman FA, Smedal MI, Wright KA. Radiotherapy for Kaposi’s sarcoma. Cancer. 1980;45:684–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Brenner B, Rakowsky E, Katz A, et al. Tailoring treatment for classical Kaposi’s sarcoma: comprehensive clinical guidelines. Int J Oncol. 1999;14:1097–102.PubMedGoogle Scholar
  21. 21.
    Yildiz F, Genc M, Akyurek S, et al. Radiotherapy in the management of Kaposi’s sarcoma: comparison of 8 Gy versus 6 Gy. J Natl Med Assoc. 2006;98:1136–9.PubMedGoogle Scholar
  22. 22.
    Caccialanza M, Marca S, Piccinno R, Eulisse G. Radiotherapy of classic and human immunodeficiency virus-related Kaposi’s sarcoma: results in 1482 lesions. J Eur Acad Dermatol Venereol. 2008;22:297–302.PubMedCrossRefGoogle Scholar
  23. 23.
    Brambilla L, Bellinvia M, Tourlaki A, Scoppio B, Gaiani F, Boneschi V. Intralesional vincristine as first-line therapy for nodular lesions in classic Kaposi sarcoma: a prospective study in 151 patients. Br J Dermatol. 2010;162:854–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Epstein JB. Treatment of oral Kaposi sarcoma with intralesional vinblastine. Cancer. 1993;71:1722–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Poignonec S, Lachiver LD, Lamas G, Coutellier A, Caumes E, Soudant J. Intralesional bleomycin for acquired immunodeficiency syndrome-associated cutaneous Kaposi’s sarcoma. Arch Dermatol. 1995;131:228.PubMedCrossRefGoogle Scholar
  26. 26.
    Brambilla L, Labianca R, Boneschi V, et al. Mediterranean Kaposi’s sarcoma in the elderly. A randomized study of oral etoposide versus vinblastine. Cancer. 1994;74:2873–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Evans SR, Krown SE, Testa MA, Cooley TP, Von Roenn JH. Phase II evaluation of low-dose oral etoposide for the treatment of relapsed or progressive AIDS-related Kaposi’s sarcoma: an AIDS Clinical Trials Group clinical study. J Clin Oncol. 2002;20:3236–41.PubMedCrossRefGoogle Scholar
  28. 28.
    Udhrain A, Skubitz KM, Northfelt DW. Pegylated liposomal doxorubicin in the treatment of AIDS-related Kaposi’s sarcoma. Int J Nanomed. 2007;2:345–52.CrossRefGoogle Scholar
  29. 29.
    Di Lorenzo G, Kreuter A, Di Trolio R, et al. Activity and safety of pegylated liposomal doxorubicin as first-line therapy in the treatment of non-visceral classic Kaposi’s sarcoma: a multicenter study. J Invest Dermatol. 2008;128:1578–80.PubMedCrossRefGoogle Scholar
  30. 30.
    Di Lorenzo G, Di Trolio R, Montesarchio V, et al. Pegylated liposomal doxorubicin as second-line therapy in the treatment of patients with advanced classic Kaposi sarcoma: a retrospective study. Cancer. 2008;112:1147–52.PubMedCrossRefGoogle Scholar
  31. 31.
    Brambilla L, Miedico A, Ferrucci S, et al. Combination of vinblastine and bleomycin as first line therapy in advanced classic Kaposi’s sarcoma. J Eur Acad Dermatol Venereol. 2006;20:1090–4.PubMedCrossRefGoogle Scholar
  32. 32.
    Brenner B, Weissmann-Brenner A, Rakowsky E, et al. Classical Kaposi sarcoma: prognostic factor analysis of 248 patients. Cancer. 2002;95:1982–7.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Pietro Curatolo
    • 1
  • Pietro Quaglino
    • 2
    Email author
  • Federica Marenco
    • 2
  • Monica Mancini
    • 1
  • Tiziana Nardò
    • 2
  • Claudio Mortera
    • 2
  • Roberta Rotunno
    • 1
  • Stefano Calvieri
    • 1
  • Maria Grazia Bernengo
    • 2
  1. 1.Department of Dermatology and Plastic Surgery, Dermatologic ClinicUniversity of Rome “La Sapienza,”RomeItaly
  2. 2.Department of Biomedical Sciences and Human Oncology, Dermatologic ClinicUniversity of TurinTurinItaly

Personalised recommendations