European e-Delphi process to define expert consensus on electrochemotherapy treatment indications, procedural aspects, and quality indicators in melanoma
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 ,   the Melanoma Delphi Working Group, Alaibac Mauro , Amerio Paolo , Ascierto Paolo , Azzarello Giuseppe , Baier Susanne , Baltas Eszter , Bartolo Joana , Bechara Falk , Bellucci Francesco , Bertino Giulia , Bonadies Antonio , Borgognoni Lorenzo , Bourke Mike , Bracken Alison , Brandani Paola , Brizio Matteo , Cabula Carlo , Calabrese Sarah , Campana Luca G , Caracò Corrado , Carriere Cinzia , Carvalhal Sara , Chiarion Vanna , Clover James , Covarelli Piero , Curatolo Pietro , Dalio Corrado , di Meo Nicola , Di Monta Gianluca , Dietrich Karin-A , Eisendle Klaus , Fabrizio Tommaso , Fantini Fabrizio , Farricha Victor , Ferraresi Virginia , Ferraù Francesco , Fierro Maria T , Galuppo Sara , Gatti Alessandro , Gehl Julie , Geimer Till , Gerlini Gianni , Gregorelli Chiara , Groselj Ales , Guida Michele , Guidoboni Massimo , Hafner Jürg , Hessam Schapoor , Hodgetts Jackie , Kelly Jason , Kis Erika , Kunte Christian , Ross Alastair McKenzie , Manca Giorgio , Mndalà Mario , Marone Ugo , Matteucci Paolo , Maurichi Andrea , Mocellin Simone , Moreno-Ramirez David , Mowatt David , Mühlstädt Michael , Muir Tobias , Mussack Thomas , Ocvirk Janja , Odili Joy , Oláh Judit , Orlando Antonio , Pascoletti Gaetano , Patuzzo Roberto , Peach Howard , Piazzalunga Dario , Porta Camillo , Powell Barry , Quaglino Pietro , Ribero Simone , Ridolfi Laura , Oom Rodrigo , Rossi Carlo R , Rossi Ernesto , Rotunno Roberta , Rutkowski Piotr , Scandurra Giusy , Sepulcri Matteo , Sersa Gregor , Sestini Serena , Snoj Marko , Soden Declan , Solari Nicola , Soma Pier F , Stingeni Luca , Strippoli Davide , Sykes Andrew , Tauceri Francesca , Testori Alessandro , Trigona Bèatrice , Turoldo Angelo , Valpione Sara , Vecchiato Antonella , Zdzienicki Marcin 
Published: May 2023

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.