Abstract
Skin metastases occur more commonly in breast cancer (BC) than in any other malignancy in women, exceeding 20 % of all cutaneous metastases. They most commonly present on the chest wall (CW), but the abdomen, back, scalp, and upper extremities also are sites of occurrence. Presentation may be ambiguous; nevertheless, their local progression may lead to extensive CW infiltration or fungating masses, with associated symptoms (e.g., bleeding, oozing, smell) and severe patient discomfort. Since cutaneous metastases portends an incurable diagnosis, the use of locoregional treatment focuses on preventing uncontrolled tumor spread, palliating symptoms, and preserving QoL. The first clinical experiences with electrochemotherapy in BC date back to the 1990s and indicated an objective response rate up to 90 %, with 59 % of subjects achieving local complete remission. More recently, following the standardization of the procedure, thanks to the adoption of the European Standard Operating Procedures of Electrochemotherapy (ESOPE) in 2006, sustained complete response rates (range, 26–58 %) have been confirmed, with durable CW control. Due to its mainly dermatologic toxicity profile, the treatment can be safely repeated, the principal concerns being pain control and lung toxicity, particularly when maximum cumulative exposure to bleomycin is reached. Early patient referral and advanced wound management are crucial aspects for ensuring patient comfort after electrochemotherapy. The most recently published experience, based on the retrospective analysis of 125 patients, indicates a 58 % complete response rate, with 86 % 1-year local progression-free survival. In this study, small tumor size, hormone receptor positivity, low proliferative index, and absence of visceral metastases were predictors of response. Electrochemotherapy represents an efficacious treatment modality for cutaneous metastases and holds promise in the management of patients with metastatic as well as locoregional (skin-only recurrence) BC. Future well-designed clinical trials will clarify the role of electrochemotherapy in BC and explore its rational combination with systemic agents.
References
Benevento R, Santoriello R, Perna G et al (2012) Electrochemotherapy of cutaneous metastases from breast cancer in elderly patients: a preliminary report. BMC Surg 12:S6
Buchanan CL, Dorn PL, Fey J et al (2006) Locoregional recurrence after mastectomy: incidence and outcomes. J Am Coll Surg 203:469–474
Cabula C (2013) Neoadjuvant electrochemotherapy of breast cancer: our experience on first case treated in Italy. Updates Surg 65:325–328
Cabula C, Campana LG, Grilz G et al (2015) Electrochemotherapy in the treatment of cutaneous metastases from breast cancer: a multicenter cohort analysis. Ann Surg Oncol 22:S442–S450
Campana LG, Mocellin S, Basso M et al (2009) Bleomycin-based electrochemotherapy: clinical outcome from a single institution’s experience with 52 patients. Ann Surg Oncol 16:191–199
Campana LG, Valpione S, Falci C et al (2012a) 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
Campana LG, Valpione S, Mocellin S et al (2012b) Electrochemotherapy for disseminated superficial metastases from malignant melanoma. Br J Surg 99:821–830
Campana LG, Galuppo S, Valpione S et al (2014) Bleomycin electrochemotherapy in elderly metastatic breast cancer patients: clinical outcome and management considerations. J Cancer Res Clin Oncol 140:1557–1565
Campana LG, Dughiero F, Forzan M et al (2016) A prototype of a flexible grid electrode to treat widespread superficial tumors by means of electrochemotherapy. Radiol Oncol 50:49–57
Cardoso F, Costa A, Norton L et al (2014) ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2). Ann Oncol 25:1871–1888
Clemons M, Danson S, Hamilton T et al (2001) Locoregionally recurrent breast cancer: incidence, risk factors and survival. Cancer Treat Rev 27:67–82
De Giorgi V, Grazzini M, Alfaioli B et al (2010) Cutaneous manifestations of breast carcinoma. Dermatol Ther 23:581–589
Groselj A, Krzan M, Kosjek T et al (2016) Bleomycin pharmacokinetics of bolus bleomycin dose in elderly cancer patients treated with electrochemotherapy. Cancer Chemother Pharmacol 77(5):939–947
Kalmykow B, Walker S (2011) Cutaneous metastases in breast cancer. Clin J Oncol Nurs 15:99–101
Katz A, Strom EA, Buchholz TA et al (2000) Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation. J Clin Oncol 18:2817–2827
Krathen RA, Orengo IF, Rosen T (2003) Cutaneous metastasis: a meta-analysis of data. South Med J 96:164–167
Ly BH, Nguyen NP, Vinh-Hung V et al (2010) Loco-regional treatment in metastatic breast cancer patients: is there a survival benefit? Breast Cancer Res Treat 119:537–545
Matthiessen LW, Johannesen HH, Hendel HW et al (2012) Electrochemotherapy for large cutaneous recurrence of breast cancer: a phase II clinical trial. Acta Oncol 51:713–721
Miklavcic D, Snoj M, Zupanic A et al (2010) Towards treatment planning and treatment of deep-seated solid tumors by electrochemotherapy. Biomed Eng Online 9:10
Mir LM, Gehl J, Sersa G et al (2006) 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 CliniporatorTM by means of invasive or non-invasive electrodes. EJC Suppl 4:14–25
Quaglino P, Matthiessen LW, Curatolo P et al (2015) Predicting patients at risk for pain associated with electrochemotherapy. Acta Oncol 54:298–306
Sersa G, Cufer T, Paulin SM et al (2012) Electrochemotherapy of chest wall breast cancer recurrence. Cancer Treat Rev 38:379–386
Sersa G, Teissie J, Cemazar M et al (2015) Electrochemotherapy of tumors as in situ vaccination boosted by immunogene electrotransfer. Cancer Immunol Immunother 64:1315–27
Sleijfer S (2001) Bleomycin-induced pneumonitis. Chest 120:617–624
Spratt DE, Gordon Spratt EA, Wu S et al (2014) Efficacy of skin-directed therapy for cutaneous metastases from advanced cancer: a meta-analysis. J Clin Oncol 32:3144–3155
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 35:32–38
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Campana, L.G., Galuppo, S., Marconato, R., Matthiessen, L.W. (2016). Electrochemotherapy for Breast Cancer. In: Miklavcic, D. (eds) Handbook of Electroporation. Springer, Cham. https://doi.org/10.1007/978-3-319-26779-1_126-1
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DOI: https://doi.org/10.1007/978-3-319-26779-1_126-1
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