European e-Delphi process to define expert consensus on electrochemotherapy treatment indications, procedural aspects, and quality indicators in melanoma

被引：3

作者：

Campana, Luca G. ^{[1
]}

Farronato, Sofia ^{[2
]}

Hodgetts, Jackie ^{[3
]}

Odili, Joy ^{[4
]}

Vecchiato, Antonella ^{[5
]}

Bracken, Alison ^{[6
]}

Baier, Susanne ^{[7
]}

Bechara, Falk G. ^{[8
]}

Borgognoni, Lorenzo ^{[9
]}

Caraco, Corrado ^{[10
]}

Carvalhal, Sara ^{[11
]}

Covarelli, Piero ^{[12
]}

Clover, James ^{[6
]}

Eisendle, Klaus ^{[13
]}

Fantini, Fabrizio ^{[14
]}

Fierro, Maria Teresa ^{[15
]}

Farricha, Victor ^{[11
]}

Gregorelli, Chiara ^{[16
]}

Hafner, Juerg ^{[17
]}

Kunte, Christian ^{[18
,19
]}

Gerlini, Gianni ^{[9
]}

Hessam, Schapoor ^{[8
]}

Mandala, Mario ^{[20
]}

Piazzalunga, Dario ^{[21
]}

Quaglino, Pietro ^{[15
]}

Snoj, Marko ^{[22
]}

Ross, Alastair Mackenzie ^{[23
]}

Trigona, Beatrice ^{[24
]}

Moreno-Ramirez, David ^{[25
]}

Tauceri, Francesca ^{[26
]}

Peach, Howard ^{[27
]}

Rutkowski, Piotr ^{[28
]}

Muir, Tobian ^{[29
]}

de Terlizzi, Francesca ^{[30
]}

Patuzzo, Roberto ^{[31
]}

Muehlstaedt, Michael ^{[24
]}

Dietrich, Karin-Almut ^{[18
]}

Mussack, Thomas ^{[32
]}

Matteucci, Paolo ^{[33
]}

Kis, Erika ^{[34
]}

Ascierto, Paolo ^{[35
]}

Sersa, Gregor ^{[36
]}

Valpione, Sara ^{[3
,37
]}

机构：

[1] Manchester Univ NHS Fdn Trust, Dept Surg, Manchester, Lancs, England

[2] Coll Hlth Care Profess Claudiana, Inst Gen Practice, Bolzano, Italy

[3] Christie NHS Fdn Trust, Med Oncol, Manchester, Lancs, England

[4] St George Hosp, Dept Plast Surg, London, England

[5] IOV IRCCS, Veneto Inst Oncol, Melanoma Unit, Padua, Italy

[6] Cork Canc Res Ctr, Cork, Ireland

[7] Azienda Sanitaria Alto Adige, Med Oncol Unit, Bolzano, Italy

[8] Ruhr Univ, St Josef Hosp, Dept Dermatol Venereol & Allergol, Bochum, Germany

[9] Santa Maria Annunziata Hosp, Dept Surg, Plast & Reconstruct Surg Unit, Florence, Italy

[10] Ist Nazl Tumori IRCCS Fdn G Pascale, Div Surg Melanoma & Skin Canc, Naples, Italy

[11] Portuguese Inst Oncol, Dept Surg, Melanoma & Sarcoma Unit, Lisbon, Portugal

[12] Univ Perugia, Dept Surg & Med, Perugia, Italy

[13] Cent Hosp Bolzano, Teaching Dept Dermatol, Bozen Bolzano, Italy

[14] Azienda Osped A Manzoni, Dermatol Unit, Lecce, Italy

[15] Univ Turin, Dept Dermatol, Turin, Italy

[16] ASST Spedali Civili, Dept Plast Surg, Brescia, Italy

[17] Univ Zurich, Dept Dermatol, Zurich, Switzerland

[18] Ludwig Maximilians Univ Munchen, Dept Dermatol & Allergol, Munich, Germany

[19] Artemed Hosp, Dept Dermatosurg & Dermatol, Munich, Germany

[20] Univ Perugia, Dept Surg & Med, Unit Med Oncol, Perugia, Italy

[21] Papa Giovanni XXIII Hosp, Gen Surg Unit, Bergamo, Italy

[22] Inst Oncol Ljubljana, Dept Surg Oncol, Ljubljana, Slovenia

[23] Guys & St Thomas NHS Fdn Trust, Dept Plast Surg, London, England

[24] Geneva Univ Hosp, Dept Med, Dermatosurg Unit, Geneva, Switzerland

[25] Virgen Macarena Univ Hosp, Dermatol Unit, Seville, Spain

[26] Morgagni Pierantoni Hosp, Gen & Oncol Surg, Forli, Italy

[27] Leeds Teaching Hosp NHS Trust, Dept Plast & Reconstruct Surg, Leeds, W Yorkshire, England

[28] Maria Sklodowska Curie Inst Oncol Ctr, Dept Soft Tissue Bone Sarcoma & Melanoma, Warsaw, Poland

[29] James Cook Univ Hosp, Dept Plast & Reconstruct Surg, Middlesbrough, Cleveland, England

[30] IGEA, Clin Biophys Dept, Modena, Italy

[31] Fdn IRCCS Ist Nazl Tumori, Melanoma Surg Unit, Milan, Italy

[32] Munich South Surg Hosp, Dept Gen & Abdominal Surg, Munich, Germany

[33] Hull Univ Teaching Hosp NHS Trust, Dept Plast & Reconstruct Surg, Kingston Upon Hull, N Humberside, England

[34] Univ Szeged, Dept Dermatol & Allergol, Szeged, Hungary

[35] INT IRCCS Fdn G Pascale, Unit Melanoma Canc Immunotherapy & Dev Therapeut, Naples, Italy

[36] Inst Oncol Ljubljana, Dept Expt Oncol, Ljubljana, Slovenia

[37] Univ Manchester, Div Immunol Immun Infect & Resp Med, Manchester, Lancs, England

来源：

BRITISH JOURNAL OF SURGERY | 2023年 / 110卷 / 07期

关键词：

ISOLATED LIMB INFUSION; REAL-TIME DELPHI; CUTANEOUS METASTASES; MALIGNANT-MELANOMA; COMPLETE RESPONSE; SKIN METASTASES; BLEOMYCIN; OUTCOMES; DISEASE; TRANSIT;

D O I：

10.1093/bjs/znad105

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

The application of electrochemotherapy in patients with melanoma lacks consensus regarding treatment indications, procedural aspects, and quality indicators. A large European expert panel engaged in a Delphi process, and provided consensus recommendations on patient selection criteria, procedural aspects of electrochemotherapy, and quality indicators with benchmarks to improve future research and current clinical practice. Lay summary Electrochemotherapy is an effective locoregional therapy for skin metastases from melanoma, a problem faced by almost half of patients with metastatic disease. The lack of comparative studies and the heterogeneity of its clinical application among centres make it challenging to support consistent, evidence-based recommendations. To address this unmet need, a three-round online survey was conducted to establish a consensus on treatment indications, standard operating procedures, and quality indicators. In the survey, a panel of 100 European melanoma experts agreed on 56 statements that can be used to improve patient selection, homogenize treatment application, and monitor outcomes. Background Skin metastases are an important co-morbidity in melanoma. Despite broad adoption, electrochemotherapy implementation is hindered by a lack of treatment indications, uncertainty regarding procedural aspects, and the absence of quality indicators. An expert consensus may harmonize the approach among centres and facilitate comparison with other therapies. Methods An interdisciplinary panel was recruited for a three-round e-Delphi survey. A literature-based 113-item questionnaire was proposed to 160 professionals from 53 European centres. Participants rated each item for relevance and degree of agreement on a five-point Likert scale, and received anonymous controlled feedback to allow revision. The items that reached concordant agreement in two successive iterations were included in the final consensus list. In the third round, quality indicator benchmarks were defined using a real-time Delphi method. Results The initial working group included 122 respondents, of whom 100 (82 per cent) completed the first round, thus qualifying for inclusion in the expert panel (49 surgeons, 29 dermatologists, 15 medical oncologists, three radiotherapists, two nurse specialists, two clinician scientists). The completion rate was 97 per cent (97 of 100) and 93 per cent (90 of 97) in the second and third rounds respectively. The final consensus list included 54 statements with benchmarks (treatment indications, (37); procedural aspects, (1); quality indicators, (16)). Conclusion An expert panel achieved consensus on the use of electrochemotherapy in melanoma, with a core set of statements providing general direction to electrochemotherapy users to refine indications, align clinical practices, and promote quality assurance programmes and local audits. The residual controversial topics set future research priorities to improve patient care.

引用

页码：818 / 830

页数：13