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Electrochemotherapy for basal cell carcinoma in the head and neck region: 5-year follow-up from the Insp-ECT registry

Ales Groselj

Ales Groselj

Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre LjubljanaLjubljana, Slovenia
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Groselj, Ales
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Giulia Bertino

Giulia Bertino

Department of Otolaryngology-Head and Neck Surgery, IRCCS Policlinico San Matteo FoundationPavia, Italy
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Bertino, Giulia
, 
Marta Minuti

Marta Minuti

Department of Otolaryngology-Head and Neck Surgery, IRCCS Policlinico San Matteo FoundationPavia, Italy
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Minuti, Marta
, 
Anthony James P Clover

Anthony James P Clover

Department of Plastic Surgery, Cork University Hospital and Cancer Research@UCC, University College Cork
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Clover, Anthony James P
, 
Camilla Kjaer Lonkvist

Camilla Kjaer Lonkvist

Department of Oncology, Herlev and Gentofte Hospital, University of CopenhagenHerlev, Denmark
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Lonkvist, Camilla Kjaer
, 
Erika Kis

Erika Kis

Department of Dermatology and Allergology, Medical University of SzegedSzeged, Hungary
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Kis, Erika
, 
Christian Kunte

Christian Kunte

  • Department of Dermatologic surgery and Dermatology, Artemed Fachklinik MünchenMunich, Germany
  • Department of Dermatology and Allergology, Ludwig-Maximilian University MunichMunich, Germany
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Kunte, Christian
, 
Tobian Muir

Tobian Muir

Plastic and Reconstructive Surgery Department, James Cook University HospitalMiddlesbrough, United Kingdom
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Muir, Tobian
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Francesco Russano

Francesco Russano

Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCSPadua, Italy
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Russano, Francesco
, 
Francesca de Terlizzi

Francesca de Terlizzi

IGEA Biophysics Lab. CarpiModena, Italy
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Terlizzi, Francesca de
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Joy Odili

Joy Odili

St George’s University Hospital NHS Foundation TrustLondon, United Kingdom
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Odili, Joy
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Gregor Sersa

Gregor Sersa

  • Department of Experimental Oncology, Institute of Oncology LjubljanaLjubljana, Slovenia
  • Faculty of Health Sciences, University of LjubljanaLjubljana, Slovenia
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Sersa, Gregor
  
Jun 21, 2025
Electrochemotherapy for basal cell carcinoma in the head and neck region: 5-year follow-up from the Insp-ECT registry's Cover Image
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Article Category: research article
Published Online: Jun 21, 2025
Page range: 233 - 243
Received: Apr 10, 2025
Accepted: Apr 18, 2025
DOI: https://doi.org/10.2478/raon-2025-0040
Keywords
© 2025 Ales Groselj et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

Types of electrodes used. (A) Type I: two plates with a 6 mm gap; (B) type IV: a wearable finger electrode with two parallel rows of needles; (C) type III: a hexagonal array with a 7.3 mm gap; or (D) type II: two parallel rows of needles with a 4 mm gap.
Types of electrodes used. (A) Type I: two plates with a 6 mm gap; (B) type IV: a wearable finger electrode with two parallel rows of needles; (C) type III: a hexagonal array with a 7.3 mm gap; or (D) type II: two parallel rows of needles with a 4 mm gap.

FIGURE 2.

Disease-free survival (DFS) of nodules treated with local (intratumoral, IT) or systemic (intravenous, IV) drug administration. YRS = years
Disease-free survival (DFS) of nodules treated with local (intratumoral, IT) or systemic (intravenous, IV) drug administration. YRS = years

FIGURE 3.

Treatment outcomes of patients treated with intravenous and intratumoral electrochemotherapy (ECT). The outcome is good in larger and smaller basal cell carcinoma (BCC) tumors. Patient No.1 (A) Recurrent BCC after multiple surgeries in a male, 82 years old patient. ECT performed under sedation and local anesthesia. Intravenous bleomycin 18200 IU. Needle row electrode; 11 pulses. Three cycles of ECT were performed (2 for the first treatment; 1 for recurrence after 2 years). (B) Result after 5 years of follow-up. Patient No. 2 (C) Primary BCC in a female, 86 years old patient with multiple severe comorbidities and non-suitable to standard treatments. One ECT session was performed under sedation and local anesthesia. Intralesional Bleomycin 1.5 ml (concentration 1 mg/ml). Needle row electrode; 7 pulses. (D) Result after 5 years of follow-up. Patient No. 3 (E) Primary BCC in a female, 69 years old patient. Patient refused standard treatments. One ECT session was performed in general anesthesia with laryngeal mask. Intravenous bleomycin 18200 IU; Hexagonal electrode; 9 pulses. (F) Result after 5 years of follow-up. Patient No.4 (G) Primary BCC in a female, 88 years old patient with severe comorbidities, Alzheimer’s disease and non-suitable to standard treatments. One ECT session was performed in general anesthesia with laryngeal mask. Intralesional bleomycin 1.5 ml (concentration 1 mg/ml); Finger electrode; 10 pulses. (H) Result after 5 years of follow-up.
Treatment outcomes of patients treated with intravenous and intratumoral electrochemotherapy (ECT). The outcome is good in larger and smaller basal cell carcinoma (BCC) tumors. Patient No.1 (A) Recurrent BCC after multiple surgeries in a male, 82 years old patient. ECT performed under sedation and local anesthesia. Intravenous bleomycin 18200 IU. Needle row electrode; 11 pulses. Three cycles of ECT were performed (2 for the first treatment; 1 for recurrence after 2 years). (B) Result after 5 years of follow-up. Patient No. 2 (C) Primary BCC in a female, 86 years old patient with multiple severe comorbidities and non-suitable to standard treatments. One ECT session was performed under sedation and local anesthesia. Intralesional Bleomycin 1.5 ml (concentration 1 mg/ml). Needle row electrode; 7 pulses. (D) Result after 5 years of follow-up. Patient No. 3 (E) Primary BCC in a female, 69 years old patient. Patient refused standard treatments. One ECT session was performed in general anesthesia with laryngeal mask. Intravenous bleomycin 18200 IU; Hexagonal electrode; 9 pulses. (F) Result after 5 years of follow-up. Patient No.4 (G) Primary BCC in a female, 88 years old patient with severe comorbidities, Alzheimer’s disease and non-suitable to standard treatments. One ECT session was performed in general anesthesia with laryngeal mask. Intralesional bleomycin 1.5 ml (concentration 1 mg/ml); Finger electrode; 10 pulses. (H) Result after 5 years of follow-up.

FIGURE 4.

Pain intensity (visual numeric scale, VNS) preelectrochemotherapy (pre-ECT), immediately post-ECT and 1 month after ECT (mean and standard error).
Pain intensity (visual numeric scale, VNS) preelectrochemotherapy (pre-ECT), immediately post-ECT and 1 month after ECT (mean and standard error).

FIGURE 5.

Kaplan-Meier survival curves for the whole population. DFS = disease free survival
Kaplan-Meier survival curves for the whole population. DFS = disease free survival

FIGURE 6.

Kaplan-Meier survival (A) of patients with small (< 3 cm) vs large (> 3 cm) lesions (B), patients with primary vs recurrent lesions (C), patients with single vs multiple lesions (D), and patients with ulcerated vs nonulcerated lesions. The differences were not significant. DFS = disease free survival; YRS = years
Kaplan-Meier survival (A) of patients with small (< 3 cm) vs large (> 3 cm) lesions (B), patients with primary vs recurrent lesions (C), patients with single vs multiple lesions (D), and patients with ulcerated vs nonulcerated lesions. The differences were not significant. DFS = disease free survival; YRS = years

Distribution of patients according to drug delivery and type of anesthesia

Local drug (IT) Systemic drug (IV)
Local anesthesia 47 53
General anesthesia 9 23

Characteristics of the recurrent patients

Pt Age Primary Previous therapy Localization Size (cm) Time recurrence (years) Treatment of the recurrence Status at 5 years of follow-up
1 82 Recurrent Surgery Nasal ala 2.5 2.9 ECT NED
2 60 Primary No Temporal region 1.8 4.1 Surgery NED
3 89 Recurrent No Nasal ala 1.7 4.7 No AWD
4 84 Recurrent No Nasolabial fold 3.0 4.7 RT AWD
5 68 Primary Surgery Tip of the nose 1.0 4.5 ECT NED
6 74 Recurrent Surgery Nasolabial fold 1.6 4.2 No AWD
7 72 Recurrent Surgery +RT Scalp 1.5 4.2 Surgery NED

Descriptive characteristics of the population

N %
GENDER
 Males 80 61%
 Female 52 39%
LESIONS’ NUMEROSITY
 Single 102 77%
 Multiple 30 23%
T STAGE
 T1 99 75%
 T2 11 8%
 T3 1 1%
 Tis 21 16%
TYPE OF TUMOR
 Primary 72 55%
 Recurrent 60 45%
ULCERATED
 No 96 73%
 Yes 36 27%
LESIONS’ PREIRRADIATION
 Yes 3 2%
PREVIOUS TREATMENTS
 Surgery 52 39%
 Radiotherapy 2 2%
 Surgery, radiotherapy 6 5%
 Surgery, other therapies 1 1%
 Surgery, radiotherapy, other therapies 2 2%
 No 69 51%

Symptoms and side effects per patient: comparison between pre-ECT values and 1-month post-ECT values

Pre-ECT 1-month post-ECT
Nausea 1 (1%) 0 (0%)
Flu 0 (0%) 0 (0%)
Suppuration 1 (1%) 2 (1%)
Hyperpigmentation 1 (1%) 10 (8%)
Ulceration 36 (27%) 14 (11%)
Crust 0 (0%) 2 (1%)
Edema/rush 0 (0%) 3 (2%)

Locations of nodules

LOCALIZATION N %
Nose 65 41%
Ear 20 12%
Forehead/temple 16 10%
Eye 16 10%
Cheek 6 4%
Scalp 5 3%
Lip 4 3%
Chin 3 2%
Neck 1 1%
Other locations 22 14%

Characteristics of the patients who experienced recurrence during the first year of follow-up

Pt Age Primary Previous therapy Localization Size (cm) Time recurrence (months) Treatment of the recurrence Status at 5 years of follow-up
1 52 Recurrent Surgery Nasal ala 1.2 7 ECT NED
2 73 Primary No Temporal region 1.5 10 Surgery NED
3 65 Recurrent Surgery Ear 1.8 11 ECT, surgery NED
4 52 Primary No Multiple (face) 3.0 11 ECT NED
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