Electrochemotherapy

Alternative, non-thermal tumor ablation procedure for the local therapy of cutaneous and subcutaneous metastases or cutaneous and subcutaneous primary tumors, first used by Mir in France, in which tumor cells are exposed in vivo to short electrical pulses of defined duration and voltage after chemotherapy has been applied. The application of the electrical procedure is referred to as electroporation or electropermeabilization. Electrochemotherapy is performed only after the prior local or systemic application of chemotherapeutic agents such as cisplatin or bleomycin. Usually palliative procedure, rarely curative.

• The aim of electroporation is to increase the cell membrane permeability of non-permeable or low-permeable tumor cell membranes by applying short high-intensity electrical pulses. The effect of electroporation is to create hydrophilic transient pores and defects in the lipid bilayers of tumor cell membranes. By increasing the cell membrane permeability of tumor cells, the permeability for locally intratumorously applied or systemically applied chemotherapeutics such as bleomycin or cisplatin is greatly improved. Local concentrations of the chemotherapeutic agents can be increased up to 10,000-fold.
• The electrical pulses can be generated either by plate electrodes or by needle electrodes implemented in tumor or metastasis. Various models serve as pulse generators, e.g. the Cliniporator (IGEA, Italy) or the Medpulser (Inovio Biomedical Corp., USA). Needle electrodes are more suitable for deeper lying tumours/metastases than superficial plate electrodes.
• The ECT procedure is used under local or general anaesthesia!
• Depending on the protocol, electroporation is performed approx. 8-28 minutes after application of the chemotherapeutic agents. The application of the current pulses varies depending on the electrodes used.

Indications are in particular subcutaneous or cutaneous melanoma metastases or in-transit metastases. Individual case reports exist for cutaneous lymphomas. Furthermore, inoperable basal cell carcinoma, squamous cell carcinoma - each with a palliative goal.

Notice. Electrochemotherapy is reserved for palliative therapy, especially for inoperable, bleeding and very painful tumors/metastases, inoperable recurrent tumors, inoperable regional metastases or when tumors/metastases are no longer amenable to any other therapy option.

1. Spugnini EP et al (2009) Electrochemotherapy for localized lymphoma: a preliminary study in companion animals. J Exp Clin Cancer Res 26: 343-346.
2. Mir LM (1994). L'électrochimiothérapie antitumorale [Antitumoral electrochemotherapy]. Pathol Biol (Paris). 42:557-560
3. Gehl J et al. (2018) Updated standard operating procedures for electrochemotherapy of cutaneous tumours and skin metastases. Acta Oncol. 57:874-882