Videos of Surgical Procedures in Dermatology
Electrochemotherapy With Intravenous Bleomycin in the Treatment of Unresectable Merkel Cell Carcinoma
Electroquimioterapia con bleomicina intravenosa en el tratamiento del carcinoma de células de Merkel irresecable
L. Padilla-España
, T. Toledo-Pastrana, A. Fernández-Orland, L. Ferrándiz-Pulido
Corresponding author
Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
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Padilla-España, T. Toledo-Pastrana, A. Fernández-Orland, L. Ferrándiz-Pulido" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Padilla-España" "email" => array:1 [ 0 => "laura.padilla.espana@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Toledo-Pastrana" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Fernández-Orland" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Ferrándiz-Pulido" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Electroquimioterapia con bleomicina intravenosa en el tratamiento del carcinoma de células de Merkel irresecable" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Electrochemotherapy (ECT) is a therapeutic procedure that combines the phenomenon of electroporation of the cell membrane with the administration of a chemotherapy drug, generally bleomycin or cisplatin. This technique is currently used for local treatment of primary and metastatic cutaneous and subcutaneous tumors, regardless of their histology.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Electroporation is a phenomenon in which the permeability of the cell membrane is increased by applying short, intense electric pulses. These pulses generate an electric field that triggers a reversible change in the cell's lipid bilayer and increases cell permeability by forming pores that, among other effects, allow the entry of drugs with high cytotoxicity but that, due to their hydrophilic nature, molecular volume, and electrical charge, have low permeability.</p><p id="par0015" class="elsevierStylePara elsevierViewall">This favors the entry of antineoplastic drugs into the cell in high concentrations, thereby increasing their antitumoral effect at lower systemic doses.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The antitumoral action of this procedure is based on 3 phenomena: 1) vasoconstriction induced by the electric pulse, which reduces vascular flow to the tumor; 2) necrosis of the vascular endothelium; and 3) stimulation of the host immune response.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The effectiveness of ECT in the treatment of tumors of different histologic characteristics has been described in palliative contexts after the failure of prior treatments, and in a neoadjuvant setting prior to surgery, chemotherapy, and radiation therapy.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In general terms, it is a well tolerated technique, although it is not free from toxic effects, which may be caused by the drug or by the technique, due to the application of the electrodes and electric pulses. The most commonly reported adverse events include local pain, ulceration, and pigmentation disorders.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Technical Description</span><p id="par0035" class="elsevierStylePara elsevierViewall">ECT is performed as major ambulatory surgery and, depending on the part of the body to be treated, the number and size of the lesions, and the baseline status of the patient, it may be performed under general or locoregional anesthetic, or under sedation.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The surgical field to be treated is prepared using regular antiseptics (chlorhexidine or povidone iodine).</p><p id="par0045" class="elsevierStylePara elsevierViewall">When the patient has been anesthetized or sedated, intravenous bleomycin is infused slowly for between 1.5 and 2<span class="elsevierStyleHsp" style=""></span>minutes. It is necessary to wait for 8<span class="elsevierStyleHsp" style=""></span>minutes before applying the electric pulses, as this interval is necessary for optimum levels of bleomycin to be reached in the blood and in the peritumoral area. The successive electric pulses must then be administered within 20<span class="elsevierStyleHsp" style=""></span>minutes. This requires inserting the electrode needles into the tumor and peritumoral tissue while simultaneously depressing the pedal that connects to the console (Cliniporator<span class="elsevierStyleSup">®</span>, Igea srl, Carpi, Italy).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indication</span><p id="par0050" class="elsevierStylePara elsevierViewall">ECT has been used in dermatology to treat cutaneous and subcutaneous metastases of melanoma,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> squamous cell carcinoma, basal cell carcinoma, Kaposi sarcoma, and metastasis of solid-organ tumors, mainly breast cancer,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and in isolated cases of Merkel cell carcinoma.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Merkel cell carcinoma (MCC), also known as primary cutaneous neuroendocrine carcinoma, is a rare tumor characterized by the fact that it affects the elderly population and has an aggressive course that can involve locoregional recurrence and metastasis.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The application of ECT in metastatic or locoregionally advanced MCC has been described in at least 10 cases,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> most of which involve patients with cutaneous and subcutaneous metastases of MCC located in the cervical and facial region; ECT was performed as palliative treatment in all cases. In general, however, a reduction was observed in the size of the metastases with consequent improvement in the symptoms of these patients.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">ECT is described as a therapeutic alternative after prior failure of surgery and radiation therapy in a 75-year-old man with a good general status, who presented multiple irresectable cutaneous and subcutaneous MCC lesions in the right leg.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusion</span><p id="par0070" class="elsevierStylePara elsevierViewall">ECT is a procedure that can be performed by dermatologists in major ambulatory surgery, with a good risk/benefit ratio, and can be used in patients diagnosed with irresectable MCC.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of Interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Technical Description" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Indication" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of Interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-05-28" "fechaAceptado" => "2018-07-02" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Padilla-España L, Toledo-Pastrana T, Fernández-Orland A, Ferrándiz-Pulido L. Electroquimioterapia con bleomicina intravenosa en el tratamiento del carcinoma de células de Merkel irresecable. 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| 2024 June | 115 | 33 | 148 |
| 2024 May | 125 | 45 | 170 |
| 2024 April | 87 | 29 | 116 |
| 2024 March | 103 | 38 | 141 |
| 2024 February | 78 | 29 | 107 |
| 2024 January | 67 | 35 | 102 |
| 2023 December | 73 | 21 | 94 |
| 2023 November | 121 | 38 | 159 |
| 2023 October | 72 | 34 | 106 |
| 2023 September | 84 | 29 | 113 |
| 2023 August | 52 | 23 | 75 |
| 2023 July | 61 | 40 | 101 |
| 2023 June | 55 | 19 | 74 |
| 2023 May | 43 | 21 | 64 |
| 2023 April | 39 | 19 | 58 |
| 2023 March | 36 | 21 | 57 |
| 2023 February | 39 | 22 | 61 |
| 2023 January | 30 | 40 | 70 |
| 2022 December | 50 | 38 | 88 |
| 2022 November | 29 | 31 | 60 |
| 2022 October | 29 | 23 | 52 |
| 2022 September | 19 | 34 | 53 |
| 2022 August | 34 | 42 | 76 |
| 2022 July | 25 | 40 | 65 |
| 2022 June | 26 | 37 | 63 |
| 2022 May | 53 | 39 | 92 |
| 2022 April | 60 | 42 | 102 |
| 2022 March | 54 | 60 | 114 |
| 2022 February | 62 | 41 | 103 |
| 2022 January | 56 | 46 | 102 |
| 2021 December | 35 | 47 | 82 |
| 2021 November | 52 | 55 | 107 |
| 2021 October | 43 | 53 | 96 |
| 2021 September | 34 | 43 | 77 |
| 2021 August | 27 | 28 | 55 |
| 2021 July | 17 | 12 | 29 |
| 2021 June | 32 | 24 | 56 |
| 2021 May | 37 | 43 | 80 |
| 2021 April | 74 | 49 | 123 |
| 2021 March | 51 | 49 | 100 |
| 2021 February | 44 | 15 | 59 |
| 2021 January | 21 | 16 | 37 |
| 2020 December | 25 | 17 | 42 |
| 2020 November | 17 | 13 | 30 |
| 2020 October | 13 | 17 | 30 |
| 2020 September | 23 | 11 | 34 |
| 2020 August | 21 | 18 | 39 |
| 2020 July | 11 | 11 | 22 |
| 2020 June | 18 | 15 | 33 |
| 2020 May | 13 | 13 | 26 |
| 2020 April | 12 | 6 | 18 |
| 2020 March | 18 | 8 | 26 |
| 2020 February | 1 | 2 | 3 |
Show all
