Abstract

Simple SummaryElectrochemotherapy (ECT) was first introduced in the late 1980s and was initially used mainly on cutaneous tumors. It has now evolved into a clinically verified treatment approach. Thanks to its high feasibility, it has been extended to treating mucosal and deep-seated tumors, including head and neck cancer (HNC) and in heavily pretreated settings. This review describes current knowledge and data on the use of ECT in various forms of HNCs across different clinical settings, with attention to future clinical and research perspectives.Despite recent advances in the development of chemotherapeutic drug, treatment for advanced cancer of the head and neck cancer (HNC) is still challenging. Options are limited by multiple factors, such as a prior history of irradiation to the tumor site as well as functional limitations. Against this background, electrochemotherapy (ECT) is a new modality which combines administration of an antineoplastic agent with locally applied electric pulses. These pulses allow the chemotherapeutic drug to penetrate the intracellular space of the tumor cells and thereby increase its cytotoxicity. ECT has shown encouraging efficacy and a tolerable safety profile in many clinical studies, including in heavily pre-treated HNC patients, and is considered a promising strategy. Efforts to improve its efficacy and broaden its application are now ongoing. Moreover, the combination of ECT with recently developed novel therapies, including immunotherapy, represented by immune checkpoint inhibitor (ICI)s, has attracted attention for its potent theoretical rationale. More extensive, well-organized clinical studies and timely updating of consensus guidelines will bring this hopeful treatment to HNC patients under challenging situations.

Highlights

  • Head and neck cancer (HNC) accounts for more than 5% of all malignancies worldwide

  • If all curative treatment options are exhausted, the patient eventually becomes a candidate for palliation, which is provided by the administration of various systemic chemotherapy regimens

  • This study focused on skin HNCs. 28 patients were treatment-naïve Tumor response was evaluated according to the assessable lesion

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Summary

Introduction

Head and neck cancer (HNC) accounts for more than 5% of all malignancies worldwide. Around 90% of cases are squamous cell carcinoma (SCC) [1]. Its use has recently been extended to deep-seated tumors [10,11,12,13,14] This local cancer treatment modality combines local or systemic administration of a chemotherapeutic drug, for example cisplatin and bleomycin, with temporal permeabilization with locally applied short-intensity high-voltage pulsed electric pulses to tumor cells. In addition to the direct antitumor function of the drug, ECT has several mechanisms of action, which may involve vascular effects and an immune response The former, a combination of the drugs and the electric pulses, causes vasoconstriction and endothelial cell death in afferent tumor vessels and subsequent blockage of tumor blood flow [24,25].

Current Clinical Application of ECT
Efficacy of ECT in HNC
Safety of ECT in HNC
Effect on QOL of ECT in HNC
Future Direction of ECT in HNC
Findings
Conclusions
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