Low electric field cancer treatment-enhanced chemotherapy (LEFCT-EC) is a new treatment modality that combines chemotherapeutic agents and low electric field stimulation. LEFCT-EC was found to destroy malignant mouse tumors and cause massive death of tumor cells. This may enable the immune system cells to efficiently recognize and eliminate tumor cells at the primary tumor site and at metastatic foci. Mice with 15 mm diameter intracutaneous colon carcinomas (CT-26) were injected with BCNU (35 mg/kg), and 2 min later the tumors were exposed to low electric fields (intensity 40 V/cm, pulse duration 180 s, frequency 500 Hz) for 12 min (LEFCT-EC). We found that treatment with LEFCT-EC achieved complete cure of 93% of the animals. In comparison, electric fields alone (13% cure), chemotherapy alone (0%), surgery (15%) or a combination of surgery and bischloroethyl-nitrosurea, carmustine (BCNU; 84%) treatments resulted in lower cure rates. After treatment and cure with LEFCT-EC, 50% of the cured mice developed resistance to a tumor challenge (surgery 1 BCNU only 15%). Furthermore, splenocytes from cured animals protected naive animals from a tumorigenic dose of tumor cells. Separation of spleen cells into lymphocyte subpopulations indicated a major role for CD4 and CD8 T cells in this protection. FACS analysis revealed restoration of normal splenocyte subpopulation proportions impaired by cytotoxic chemotherapy. Our results suggest that LEFCT-EC can directly destroy primary tumors and facilitate the destruction of metastatic disease by enforcement of antitumor immune responses. ' 2005 Wiley-Liss, Inc.Key words: electrostimulation; metastases; colon cancer; chemotherapy; antitumor immune response About 11% of all new cancer cases in the USA in 2004 are colorectal cancer (CRC), making it the third most common malignancy in both sexes in developed countries. 1 Surgical resection remains the primary treatment modality for localized disease with a relapse-free rate of approx. 50%. 2 Although 15-20% of initially diagnosed patients with CRC have distant metastases, most patients develop metastasis at some point during the disease cycle, and the 5-year survival rate with metastasis has been reported as <5%. 3 We report here a recently developed method for the treatment of metastatic malignancies, which takes advantage of the specific synergistic effects of low electric fields and chemotherapy. This approach is based on the phenomenon of electrically enhanced endocytosis (electroendocytosis) of macromolecules (molecular weight of 1-2,000 kD) after exposure of cells to low unipolarpulsed electric fields (2.5-80V/cm). [4][5][6] It should be stressed that this process differs fundamentally from that of electroporation. Electroporation, which was initially discovered more than 2 decades ago, is characterized by induction of very short-lived (in the microsecond time domain) permeability changes in the plasma membrane by high electric fields (250-5,000 V/cm). The typical exposure to fields inducing electroporation consists of a sing...