Electrochemotherapy (ECT) is a local treatment and its use has been standardized for cutaneous nodules of any histologic origin. In the present study we use ECT as a neoadjuvant therapy in order to reduce the size of neoplastic lesions to obtain an ideal cleavage plane where vital or very important vascular and/or nervous structures are separated from the tumor, thus allowing a radical surgical excision, otherwise unfeasible. In their retrospective study the authors identified 41 patients that were treated at our institution with neoadjuvant intent. ECT was performed under general (30 pts, 73%), regional (9 pts, 22%) or local anaesthesia with sedation (2 pts, 5%). At a median time of 2 months (range 0.3-9) after neoadjuvant ECT, all patients underwent surgical intervention, in order to resect the residual tumour. Median reduction of tumour volume after ECT was 55% (range 10%-65%). After ECT plus surgery, 25 patients (61%) had a complete response (CR), 16 patients (39%) a partial response (PR). The percentage of CR in patients with larger lesions (>100mm) was 27%, in patients with smaller lesions (≤100mm) was 73% (p=0.0119). Major side effects after ECT were: bleeding and/or ulceration (54%) and pain (59%) naturally resolved in 1-2 months. Side effects observed after surgery were: necrosis of the flap (N=3), a case of diastasis of the donor site. Median survival time in CR patients was 53 months (range 4-108), whereas in PR survival was 23 months (range 5-126), p=0.0400. ECT represents a safe and effective therapeutic approach that could be effectively used for neoadjuvant purposes.
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