Martin Weiß

Electrochemotherapy as a symptom-oriented palliative treatment option: an exploratory single-center study in 15 patients with locally advanced or locoregionally recurrent vulvar carcinoma

Abstract Background Vulvar carcinoma (VC), a rare cancer, recurs in over a third of women, usually within 2 years. Treatment options other than repeat surgery and radiotherapy are often required in the recurrence setting. Systemic chemotherapy is an option but is generally associated with stressful side effects. In the palliative setting, electrochemotherapy (ECT) is a better-tolerated alternative, which provides local tumor control while obviating systemic side effects. Objective To descriptively analyze a case series of patients with inoperable locally advanced or locoregionally recurrent VC receiving bleomycin-based ECT. Methods Descriptive analysis of prospectively collected data from a case series. Postmenopausal women with locally advanced or locoregionally recurrent VC were eligible for inclusion. Bleomycin was administered at 15 mg/m 2 body surface as a single 1-min intravenous injection; 8 min later, electrochemical treatment using sterile disposable electrodes was performed under anesthesia for ≤ 30 min. Postoperatively, patients received pain medication to mitigate muscle soreness. Results 15 patients were included in the study. Median patient age at ECT was 81 (range, 51–100) years. Recurrences (1–5) were present in 12 patients. Surgery and radiotherapy were not justifiable options in 3 patients. In our clinical observation, ECT was well tolerated by all patients for the management of pain, itching, odor, and secretion. This allowed for time to be gained until further treatment became necessary or disease progression occurred. Conclusions In our clinical experience, bleomycin-based ECT is an oncologically efficacious and better-tolerated alternative to systemic chemotherapy or immunotherapy in patients with recurrent VC in a palliative setting with limited capacity to undergo treatment.

Hyperspectral imaging as a new diagnostic tool for cervical intraepithelial neoplasia

Abstract Purpose Cervical cancer screening by visual inspection with acetic acid (VIA) during colposcopy can be challenging and is highly dependent on the clinical experience of the examiner. Health-care systems lack qualified physicians able to perform the examination in both industrialized and low- and middle-income countries. Previous work has shown the general potential of hyperspectral imaging (HSI) to discriminate CIN from normal tissue, but clinical translation has been limited due to the lack of medically approved HSI systems. Methods In this study, we evaluate the feasibility of a commercially available HSI system for CIN detection in a prospective monocentric clinical trial. Results By obtaining spectral fingerprints of 41 patients with CIN 1–3 we show that HSI-based differentiation between CIN and normal tissue is possible with high statistical significance. Major spectral differences were seen in the 555–585 wavelength area. Conclusion HSI advances tissue differentiation by associating each pixel with high-dimensional spectra and thereby obtains morphological and biochemical information of the observed tissue. Currently available and medically approved HSI systems may represent a contact- and marker-free examiner-independent method for the diagnosis of CIN.

Detection of Cervical Intraepithelial Neoplasia Using Hyperspectral Tissue Signatures

Cervical intraepithelial neoplasia (CIN) represents a spectrum of premalignant lesions requiring accurate early detection to prevent progression to invasive cervical cancer. Colposcopy with visual inspection using acetic acid (VIA) is the gold standard for CIN assessment but suffers from substantial interobserver variability, limiting diagnostic consistency. We evaluated hyperspectral imaging (HSI) as an objective, non-invasive method for characterizing CIN-related tissue changes. This prospective proof-of-principle clinical study enrolled women with histologically confirmed CIN3 indicated for large-loop excision of the transformation zone (LLETZ). Standardized colposcopic images following VIA were obtained and annotated independently by five certified colposcopists according to IFCPC Rio 2011 classification. These annotations served as pathological tissue region references and were quantitatively assessed using intersection over union metrics to evaluate interobserver agreement. HSI was performed immediately prior to LLETZ using the TIVITA Tissue System, capturing spectral reflectance data across 500-995 nm in 100 wavelength bands. Spatial correspondence between colposcopic and hyperspectral images was achieved through homography transformation based on landmark alignment, allowing expert annotations to be projected into the HSI domain. Reflectance spectra from annotated areas were averaged to calculate four proprietary HSI-derived tissue indices, which revealed significantly higher values in CIN-affected regions compared to healthy tissue (p <0.01, Wilcoxon signed-rank test), suggesting increased vascularization and water content. Our findings highlight conventional colposcopy limitations due to examiner subjectivity and support HSI's potential to provide reproducible, quantitative biomarkers for CIN. HSI integration into clinical workflows may enhance cervical cancer screening objectivity and enable reliable diagnostics in resource-limited settings. Clinical and Translational Impact Statement- Hyperspectral imaging enables objective detection of cervical intraepithelial neoplasia and could improve diagnostic accuracy while reducing unnecessary biopsies.