A novel application of calcium electroporation to cutaneous manifestations of gynaecological cancer
1Department of Obstetrics and Gynaecology, The Hillingdon Hospitals NHS Foundation Trust, UB8 3NN London, UK
2Department of Gynaecological Oncology, Institute of Reproductive & Developmental Biology, Imperial College London, W12 0HS London, UK
3Department of Obstetrics and Gynaecology, Imperial College NHS Healthcare Trust, W12 0HS London, UK
4Department of Obstetrics and Gynaecology, St Mary’s Hospital, W2 1NY London, UK
5Department of Gynaecological Oncology, Imperial College NHS Trust, W12 0HS London, UK
6Division of Surgery and Cancer, Imperial College London, W12 0HS London, UK
7Department of Obstetrics and Gynaecology, North Middlesex NHS Trust, N18 1QX London, UK
8West London Gynaecological Cancer Centre, Queen Charlotte’s Hospital, Imperial College London, W12 0HS London, UK
9Department of Medical Oncology, Imperial College London, W12 0HS London, UK
10West London Gynaecological Cancer Centre, Queen Charlotte’s Hospital, Imperial College London, W12 0HS London, UK
DOI: 10.31083/j.ejgo4204102 Vol.42,Issue 4,August 2021 pp.662-672
Submitted: 12 December 2020 Accepted: 12 March 2021
Published: 15 August 2021
Objective: Calcium electroporation (CaEP) is a new technique whereby intracellular concentrations of calcium are elevated by transient permeabilisation of the cell membrane using high-voltage electrical pulses. Tumour necrosis is induced with little damage to healthy tissue. Within gynaecological cancer, vulval cancer and vulval intraepithelial neoplasia (VIN) pose challenges for treatment, given the high recurrence rate, persistent symptoms and repeated resections required. In certain cases, CaEP may provide a suitable alternative. Methods: We present a case series of six patients with recurrent vulval squamous cell carcinoma (n = 2), VIN III (n = 2) and metastatic ovarian cancer (n = 2), five of whom were treated with CaEP. This is the first known application of CaEP to gynaecological cancers. Results: The median follow-up time was 14 months (range 2–18 months). Within the cohort of patients, CaEP was applied a total of 10 times, achieving a complete response five times and partial response four times. Symptoms improved within six weeks for eight episodes following CaEP application. Beyond six weeks, symptoms eventually recurred in all patients and four patients required more than one CaEP procedure. CaEP was useful for palliation of distressing symptoms in one case of metastatic ovarian cancer. No intra-operative or post-operative complications have been reported to date. Conclusion: CaEP may be a promising short-term treatment in selected patients with recurrent VIN and vulval cancer, where other treatments had failed. If validated, it could provide an acceptable alternative where surgery is unacceptable. Long term follow-up is required to evaluate effects on recurrence.
Calcium; Electroporation; Ovarian cancer; Vulval cancer; VIN
Yousra Ahmed-Salim,Srdjan Saso,Hannah E Meehan,Nicolas Galazis,David L Phelps,Benjamin P Jones,Maxine Chan,Mehar Chawla,Kostas Lathouras,Hani Gabra,Christina Fotopoulou,Sadaf Ghaem-Maghami,James Richard Smith. A novel application of calcium electroporation to cutaneous manifestations of gynaecological cancer. European Journal of Gynaecological Oncology. 2021. 42(4);662-672.
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