Electrochemotherapy: A New Technological Approach in Treatment of Metastases in the Liver

Abstract

Electrochemotherapy is now in development for treatment of deep-seated tumors, like in bones and internal organs, such as liver. The technology is available with a newly developed electric pulse generator and long needle electrodes; however the procedures for the treatment are not standardized yet. In order to describe the treatment procedure, including treatment planning, within the ongoing clinical study, a case of successful treatment of a solitary metastasis in the liver of colorectal cancer is presented. The procedure was performed intraoperatively by inserting long needle electrodes, two in the center of the tumor and four around the tumor into the normal tissue. The insertion of electrodes proved to be feasible and was done according to the treatment plan, prepared by numerical modeling. After intravenous bolus injection of bleomycin the tumor was exposed to electric pulses. The delivery of the electric pulses did not interfere with functioning of the heart, since the pulses were synchronized with electrocardiogram in order to be delivered outside the vulnerable period of the ventricles. Also the post treatment period was uneventful without side effects. Re-operation of the treated metastasis demonstrated feasibility of the reoperation, without secondary effects of electrochemotherapy on normal tissue. Good antitumor effectiveness with complete tumor destruction was confirmed with histological analysis. The patient is disease-free 16 months after the procedure. In conclusion, treatment procedure for electrochemotherapy proved to be a feasible technological approach for treatment of liver metastasis. Due to the absence of the side effects and the first complete destruction of the treated tumor, treatment procedure for electrochemotherapy seems to be a safe method for treatment of liver metastases with good treatment effectiveness even in difficult-to-reach locations.

Cellular stress induced by photodynamic reaction with CoTPPS and MnTMPyPCl5 in combination with electroporation in human colon adenocarcinoma cell lines (LoVo and LoVoDX)

“…The procedure was performed intraoperatively by inserting long needle electrodes, two in the center of the tumor and four around the tumor into the normal tissue. The authors obtained good antitumor effectiveness with complete tumor destruction, which was confirmed with a histological analysis (Edhemovic et al 2011).…”

“…For this type of cancer, they obtained a positive treatment effect only for BLM (Kuriyama et al 2000). Edhemovic et al (2011) described a case of a successful treatment of a solitary metastasis of colorectal cancer in the liver. The procedure was performed intraoperatively by inserting long needle electrodes, two in the center of the tumor and four around the tumor into the normal tissue.…”

Planning of Electroporation-Based Treatments Using Web-Based Treatment-Planning Software

“…The electric field is caused by high-voltage electric pulses that are delivered to the target tissue (i.e., tumor) using electrodes (Mir et al 1991). ECT is already used in clinical practice for treating metastases of skin melanoma in more than 100 clinical institutions in Europe ) and has already been introduced to clinical trials for treating deep-seated metastases in the liver (Edhemović et al 2011), brain (AgerholmLarsen et al 2011;Linnert et al 2012;Mahmood and Gehl 2011), bone (Fini et al 2011) and soft tissue (Neal et al 2011). While following standard operating procedures (Mir et al 2006) ensures safe and successful treatment of skin melanoma metastases (Marty et al 2006), patient-specific treatment planning is nevertheless required for ECT of deep-seated tumors (Pavliha et al 2012).…”

Operating Procedures of the Electrochemotherapy for Treatment of Tumor in Dogs and Cats

“…However, the configuration of the electrodes is a technological feature that is fast developing and now different sets of electrodes are used for specific administrations long-needle single electrodes for metastases of colorectal tumors in the liver 25 , bone metastases 7 , soft tissue sarcoma 26 , endoluminal electrodes for colorectal, gastric and esophageal tumors 27 and expandable ''umbrella'' type electrodes for brain tumors 8 .…”