Background: Vulvar cancer is a disease that is primarily treated by surgery and/or radiotherapy. Due to previous procedures, repeated surgical procedures lead to mutilation of the vulvar area, which worsens patients’ quality of life. Electrochemotherapy is a local ablative therapy used for the treatment of various superficial and deep-seated tumours. Electrochemotherapy involves the application of electric pulses locally to tumours to destabilize cell membranes and facilitate the entry of cytotoxic drugs, thereby enhancing their cytotoxicity locally. Until 2020, the use of electrochemotherapy in patients with vulvar cancer has been reported only in a limited number of studies and case reports, and exclusively for palliative purposes. To date, no published study has evaluated the use of electrochemotherapy in the treatment of local recurrence of vulvar cancer.
Aim of the study: The aim of the study was to investigate the safety, feasibility and effectiveness of electrochemotherapy in patients with recurrent vulvar cancer and to evaluate the quality of life of women treated with electrochemotherapy.
Methods: Eleven patients with recurrent vulvar cancer were treated with electrochemotherapy from July 2020 to December 2023, according to predefined inclusion and exclusion criteria. Follow-up examinations after treatment with electrochemotherapy were carried out at precisely defined intervals: at 1, 2, 3, 6, 9, and 12 months after electrochemotherapy, and regularly thereafter in accordance with the recommendations for the follow-up of patients with vulvar cancer. The safety of electrochemotherapy was determined by recording adverse events using the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE). Feasibility of electrochemotherapy for vulvar cancer was determined using electrodes from the same manufacturer with different but fixed electrode arrangements. Following the standard operating procedures for electrochemotherapy, the electrodes were precisely inserted into the tumour, and their position relative to the tumour was determined to ensure optimal coverage of the tumour with electrical current. The effectiveness of the electrochemotherapy was evaluated on the basis of the clinical response, according to the RECIST (Response Evaluation Criteria in Solid Tumors) guidelines. The effectiveness of electrochemotherapy treatment was compared with a control group of fifteen patients with recurrent vulvar cancer who underwent wide local excision with a macroscopic tumour-free surgical margin of at least one centimetre. Quality of life was assessed using questionnaires. Patients completed the European Quality of Life Questionnaire EuroQol - 5 Dimension (EQ-5D), the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Vulva Cancer (EORTC QLQ-VU34) and the Visual Analogue Pain Scale (VAS) questionnaire.
Results: With the appropriate electrode selection, depending on the location and size of the tumour, electrochemotherapy was feasible in all patients. No adverse effects occurred during or after electrochemotherapy. Treatment of recurrent vulvar cancer with electrochemotherapy for non-palliative purposes was comparable to surgical treatment in terms of effectiveness. The study showed that the quality of life of women with recurrent vulvar cancer after treatment with electrochemotherapy is better in some areas than after surgical treatment.
Conclusions: This was the first study to investigate the use of electrochemotherapy in vulvar cancer for non-palliative purposes. We have shown that electrochemotherapy is a safe, feasible, and effective method for the treatment of vulvar cancer. Treatment with electrochemotherapy improves the quality of life of patients with recurrent vulvar cancer.
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