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The activity and safety of electrochemotherapy in persistent chest wall recurrence from breast cancer after mastectomy: a phase-II study

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Abstract

Electrochemotherapy (ECT) represents an attractive locoregional therapy for unresectable chest wall recurrence (CWR) from breast cancer. Thirty-five patients with cutaneous CWR after mastectomy who experienced progression despite re-irradiation and extensive systemic treatments were administered bleomycin-based ECT. Local response, toxicity, and superficial control were evaluated. Out of 516 metastases (median 15/patient, range 1–50), response was assessed on 196 target lesions (median size 20 mm, range 10–220). Patients received a median of 2 ECT courses (range 1–3). Two-month objective response was as follows: 54.3 % complete (19/35 patients), 37.1 % partial (13/35), and 8.6 % no change (3/35). Twenty-three patients (65.7 %) developed new lesions (NL) after a median time of 6.6 months (range 2.3–29.5), therefore 1, 2, or 3 ECT cycles were required in 14, 15, and 6 patients, respectively. Median follow-up was 32 months (range 6–53) and the 3-year local control rate was 81 %. Related morbidity was mild, increased after retreatments and consisted primarily of pain (reported as “moderate”/“severe” by 6, 13, and 17 % of patients 1 month after the first, second, and third application, respectively) and dermatological toxicity (acute G3 skin ulceration in 14, 20, and 33 % of patients, respectively). Less than 10 metastases (P < 0.001), the narrower area of tumor spread on the chest wall (P = 0.022), complete response achievement (P = 0.019), and post-ECT endocrine instead of chemotherapy (P = 0.025) were associated to NL-free survival. Only fewer skin metastases, hazard ratio (HR) 0.122, 95 % confidence interval (CI) 0.037–0.397, P < 0.001, and contained superficial spread, HR 0.234, 95 % CI 0.067–0.818, P = 0.023, were predictors for longer NL-free survival. ECT showed a satisfactory activity in refractory breast cancer CWR, providing sustained local control. Patients with fewer and less scattered skin metastases are less likely to develop NL. Partial responders and NL can be handled with additional ECT albeit increasing local pain and skin toxicity.

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References

  1. Spratt JS (1967) Locally recurrent cancer after radical mastectomy. Cancer 20:1051–1053

    Article  PubMed  CAS  Google Scholar 

  2. Valagussa P, Bonadonna G, Veronesi U (1978) Patterns of relapse and survival following radical mastectomy. Cancer 41:1170–1178

    Article  PubMed  CAS  Google Scholar 

  3. Bedwinek J (1994) Natural history and management of isolated locoregional recurrence following mastectomy. Semin Radiat Oncol 4:260–269

    Article  PubMed  Google Scholar 

  4. Arriagada R, Le MG, Rochard F, Contesso G (1996) Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol 14:1558

    PubMed  CAS  Google Scholar 

  5. Buchanan CL, Dorn PL, Fey J et al (2006) Locoregional recurrence after mastectomy: incidence and outcomes. J Am Coll Surg 203:469

    Article  PubMed  Google Scholar 

  6. van Tienhoven G, Voogd AC, Peterse JL et al (1999) Prognosis after treatment for loco-regional recurrence after mastectomy or breast conserving therapy in two randomised trials (EORTC 10801 and DBCG-82TM). EORTC Breast Cancer Cooperative Group and the Danish Breast Cancer Cooperative Group. Eur J Cancer 35:32

    Article  PubMed  Google Scholar 

  7. Willner J, Kiricuta IC, Kolbl O (1997) Locoregional recurrence of breast cancer following mastectomy: always a fatal event? Results of univariate and multivariate analysis. Int J Radiat Oncol Biol Phys 37:853

    Article  PubMed  CAS  Google Scholar 

  8. Haylock BJ, Coppin CM, Jackson J et al (2000) Locoregional first recurrence after mastectomy: prospective cohort studies with and without immediate chemotherapy. Int J Radiat Oncol Biol Phys 46:355

    Article  PubMed  CAS  Google Scholar 

  9. Rauschecker H, Clarke M, Gatzemeier W, Recht (2001) A. Systemic therapy for treating locoregional recurrence in women with breast cancer. Cochrane Database Syst Rev. (4):CD002195

  10. Rols MP (2006) Electropermeabilization, a physical method for the delivery of therapeutic molecules into cells. Biochim Biophys Acta 1758(3):423–428

    Article  PubMed  CAS  Google Scholar 

  11. Quaglino P, Mortera C, Osella-Abate S, Barberis M, Illengo M, Rissone M, Savoia P, Bernengo MG (2008) Electrochemotherapy with intravenous bleomycin in the local treatment of skin melanoma metastases. Ann Surg Oncol 15(8):2215–2222

    Article  PubMed  CAS  Google Scholar 

  12. Campana LG, Mocellin S, Basso M, Puccetti O, De Salvo GL, Chiarion-Sileni V, Vecchiato A, Corti L, Rossi CR, Nitti D (2009) Bleomycin-based electrochemotherapy: clinical outcome from a single institution’s experience with 52 patients. Ann Surg Oncol 16(1):191–199

    Article  PubMed  Google Scholar 

  13. Matthiessen LW, Chalmers RL, Sainsbury DC, Veeramani S, Kessell G, Humphreys AC, Bond JE, Muir T, Gehl J (2011) Management of cutaneous metastases using electrochemotherapy. Acta Oncol 50(5):621–629

    Article  PubMed  Google Scholar 

  14. Sersa G, Cufer T, Paulin SM, Cemazar M, Snoj M (2011) Electrochemotherapy of chest wall breast cancer recurrence. Cancer Treat Rev. doi:10.1016/j.ctrv.2011.07.006

    Google Scholar 

  15. Marty M, Sersa G, Garbay J, Gehl J, Collins C, Snoj M et al (2006) Electrochemotherapy––an easy, highly effective and safe treatment of cutaneous and subcutaneous metastases: results of ESOPE (European Standard Operating Procedures of Electrochemotherapy) study. EJC Suppl 4:3–13

    Article  CAS  Google Scholar 

  16. Larkin J, Collins C, Aaron S, Tangney M, Whelan M, O’Reily S et al (2007) Electrochemotherapy––aspects of preclinical development and early clinical experience. Ann Surg 245:469–479

    Article  PubMed  Google Scholar 

  17. Rebersek M, Cufer T, Cemazar M, Kranjc S, Sersa G (2004) Electrochemotherapy with cisplatin of cutaneous tumor lesions in breast cancer. Anticancer Drugs 15:593–597

    Article  PubMed  CAS  Google Scholar 

  18. Mir L, Glass L, Sersa G, Teissie J, Domenge C, Miklavcic D et al (1998) Effective treatment of cutaneous and subcutaneous malignant tumors by electrochemotherapy. Br J Cancer 77:2336–2342

    Article  PubMed  CAS  Google Scholar 

  19. Whelan MC, Larkin JO, Collins CG, Cashman J, Breathnach O, Soden DM et al (2006) Effective treatment of an extensive recurrent breast cancer which was refractory to multimodal therapy with multiple applications of electrochemotherapy. EJC Suppl 4:32–34

    Article  Google Scholar 

  20. Therasse P, Arbuck SG, Eisenhauer EA (2000) 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 92:205–216

    Article  PubMed  CAS  Google Scholar 

  21. Cancer Therapy Evaluation Program (2006) Common terminology criteria for adverse events, version 3.0, DCTD, NCI, NIH, DHHS March 31, 2003. http://ctep.cancer.gov. Accessed Aug 9 2006

  22. Clarke M, Collins R, Darby S et al (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview o the randomised trials. Lancet 366:2087–2106

    PubMed  CAS  Google Scholar 

  23. Campana LG, Valpione S, Mocellin S (2012) Disease control in patients with disseminated superficial melanoma metastases treated with electrochemotherapy. Br J Surg (in press)

  24. Aberizk WJ, Silver B, Henderson IC et al (1986) The use of radiotherapy for treatment of isolated locoregional recurrence of breast carcinoma after mastectomy. Cancer 58:1214

    Article  PubMed  CAS  Google Scholar 

  25. Deutsch M, Parsons JA, Mittal BB (1986) Radiation therapy for local-regional recurrent breast carcinoma. Int J Radiat Oncol Biol Phys 12:2061

    Article  PubMed  CAS  Google Scholar 

  26. Halverson KJ, Perez CA, Kuske RR et al (1990) Isolated local-regional recurrence of breast cancer following mastectomy: radiotherapeutic management. Int J Radiat Oncol Biol Phys 19:851

    Article  PubMed  CAS  Google Scholar 

  27. Schwaibold F, Fowble BL, Solin LJ et al (1991) The results of radiation therapy for isolated local regional recurrence after mastectomy. Int J Radiat Oncol Biol Phys 21:299

    Article  PubMed  CAS  Google Scholar 

  28. Ballo MT, Strom EA, Prost H et al (1999) Local-regional control of recurrent breast carcinoma after mastectomy: does hyperfractionated accelerated radiotherapy improve local control? Int J Radiat Oncol Biol Phys 44:105

    Article  PubMed  CAS  Google Scholar 

  29. Wahl AO, Rademaker A, Kiel KD et al (2008) Multi-institutional review of repeat irradiation of chest wall and breast for recurrent breast cancer. Int J Radiat Oncol Biol Phys 70:477

    Article  PubMed  Google Scholar 

  30. Sersa G, Kranjc S, Cemazar M (2000) Improvement of combined modality therapy with cisplatin and radiation using electroporation of tumors. Int J Radiation Oncology Biol Phys 4:1037–1041

    Article  Google Scholar 

  31. Kranjc S, Tevz G, Kamensek U, Vidic S, Cemazar M, Sersa G (2009) Radiosensitising effect of electrochemotherapy in a fractionated radiation regimen in radiosensitive murine sarcoma and radioresistant adenocarcinoma tumor model. Radiat Res 172:677–685

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

Angelo Ciccarese, MD, Connie Celentano, MD, and Sandra Cappellato, MD, Anesthesiology Section, Sara Galuppo, MD, and Guido Sotti, MD, Radiotherapy Section, Cristina Ghiotto, MD, Medical Oncology-II, Antonella Brunello, MD, Medical Oncology-I, for patients’ assistance; Angelo C. Palozzo, MD, Francesco Paganelli, MD, and Sonia Faoro, MD, Clinical Pharmacology Unit, for bleomycin preparation; Ms. Denise Kilmartin, Clinical Trials and Biostatistics Unit, Veneto Region Oncology Research Institute, Padova, for editing the paper. The precious discussions with Vanna Chiarion-Sileni, MD, and the support of Ms. Romina Spina and Mr. Matteo Vescuso for data collection and graphs implementation are gratefully acknowledged.

Conflict of interest

The authors have no conflict of interest.

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Authors and Affiliations

  1. Sarcoma and Melanoma Unit, Veneto Region Oncology Research Institute (IOV-IRCCS), University of Padova, Via Gattamelata, 64, 35128, Padua, Italy

    Luca G. Campana & Carlo R. Rossi

  2. Medical Oncology School, University of Padova, Padua, Italy

    Sara Valpione

  3. Medical Oncology Unit-II, Veneto Region Oncology Research Institute (IOV-IRCCS), Padua, Italy

    Cristina Falci

  4. Surgery Branch, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy

    Simone Mocellin & Alberto Marchet

  5. Radiotherapy Unit, Veneto Region Oncology Research Institute (IOV-IRCCS), Padua, Italy

    Michela Basso & Luigi Corti

  6. Breast Unit, Ca’Foncello Regional Hospital, Treviso, Italy

    Nicola Balestrieri

Authors
  1. Luca G. Campana
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  2. Sara Valpione
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  3. Cristina Falci
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  4. Simone Mocellin
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  5. Michela Basso
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  6. Luigi Corti
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  7. Nicola Balestrieri
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  8. Alberto Marchet
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  9. Carlo R. Rossi
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Correspondence to Luca G. Campana.

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Campana, L.G., Valpione, S., Falci, C. et al. The activity and safety of electrochemotherapy in persistent chest wall recurrence from breast cancer after mastectomy: a phase-II study. Breast Cancer Res Treat 134, 1169–1178 (2012). https://doi.org/10.1007/s10549-012-2095-4

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  • DOI: https://doi.org/10.1007/s10549-012-2095-4

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