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

• Published in: British journal of surgery 2023-06, Vol.110 (7), p.818-830
• Main Authors: Campana, Luca G, Farronato, Sofia, Hodgetts, Jackie, Odili, Joy, Vecchiato, Antonella, Bracken, Alison, Baier, Susanne, Bechara, Falk G, Borgognoni, Lorenzo, Caracò, Corrado, Carvalhal, Sara, Covarelli, Piero, Clover, James, Eisendle, Klaus, Fantini, Fabrizio, Fierro, Maria Teresa, Farricha, Victor, Gregorelli, Chiara, Hafner, Jürg, Kunte, Christian, Gerlini, Gianni, Hessam, Schapoor, Mandalà, Mario, Piazzalunga, Dario, Quaglino, Pietro, Snoj, Marko, Ross, Alastair Mackenzie, Trigona, Béatrice, Moreno-Ramirez, David, Tauceri, Francesca, Peach, Howard, Rutkowski, Piotr, Muir, Tobian, de Terlizzi, Francesca, Patuzzo, Roberto, Mühlstädt, Michael, Dietrich, Karin-Almut, Mussack, Thomas, Matteucci, Paolo, Kis, Erika, Ascierto, Paolo, Sersa, Gregor, Valpione, Sara
• Format: Article
• Language: English
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1093/bjs/znad105

Abstract 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. 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