Minimally invasive treatment of peristomal metastases from gastric cancer at an ileostomy site by electrochemotherapy

Abstract

BackgroundPeristomal metastases are rare, but potentially associated with relevant morbidity. Surgical resection, followed by stoma relocation, represent the gold standard in most patients. We describe electrochemotherapy (ECT), a minimally invasive method for locally-enhancing drug delivery by means of electric pulses, as an alternative approach.Patient and methodsA 49-year-old man with advanced gastric cancer developed skin metastases around an ileostomy site. The ulcerated and oozing tumor growth impaired patient’s quality of life due to continuous trouble in fitting the ostomy appliance, its poor adherence and consequent stools spillage. ECT consisted of a 20-minute course under mild general sedation. A bleomycin bolus of 15 000 IU/m2 was followed by the percutaneous application of multiple, 1.5 ms -long electric pulses by means of a needle electrode.ResultsPost ECT course was uneventful and the patient was discharged on the same day. After one week, tumor nodules were flattened and partial tumor regression was appreciable at one-month follow-up. More importantly, peristomal skin conditions significantly improved, thus allowing for an effective application of the ostomy appliance during the following moths, until patient’s death.ConclusionsThis report suggests the feasibility of ECT as a minimally invasive approach for peristomal tumors. In selected cases, ECT, by achieving a rapid tumor control, may ensure effective ostomy management and preserve patients’ quality of life.

Skin complications in patients with an intestinal stoma

“…Zmiany mogą być bolesne, asymetryczne, o różnych barwach i różnej średnicy. Mogą też krwawić, co dodatkowo utrudnia przymocowanie sprzętu do zaopatrzenia stomii [26]. W postępowaniu należy uwzględnić pobranie materiału ze zmiany do oceny histopatologicznej oraz wdrożenie odpowiedniego leczenia.…”

Electrochemotherapy of superficial tumors – Current status:

“…Several solid organ and hematologic neoplasms can metastasize to the skin, with an overall incidence of 0.7-10% [225][226][227] . ECT has been occasionally investigated to palliate patients with lung, gastric, bladder, and kidney cancer [11,191,200,228,229] . However, because the evidence relies on isolated reports, any possible clinical benefit must be carefully evaluated on an individual basis.…”

“…However, because the evidence relies on isolated reports, any possible clinical benefit must be carefully evaluated on an individual basis. ECT has been proposed for the management of skin tumor infiltration around an ostomy site, which can occur either in head and neck cancer patients or in those with metastatic abdominal malignancies, posing a palliation challenge [190,228] . In these cases, ECT aims at maintaining airway patency or reducing the adherence of the flange around the ostomy.…”

“…Sporadic primary cutaneous T-or B-cell lymphomas (eg, mycosis fungoides and marginal zone lymphoma) have been managed by ECT, with extended disease-free follow-up [190,202,228,230] . More studies will be necessary, however, to draw conclusions.…”

A prototype of a flexible grid electrode to treat widespread superficial tumors by means of Electrochemotherapy

“…In recent years, ECT has shown efficacy in several tumors types and has been adopted by several centers for the treatment of skin tumors and, most of all, superficial metastases with the aim to improve local tumor control without discontinuation of concomitant systemic treatments. 4 , 8 – 13 Among ECT indications, breast cancer (BC) represents a promising, but challenging field. Chest wall recurrence ( i.e.…”