Electrochemotherapy: a new technological approach in treatment of metastases in the liver.

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.

Increasing the repetition frequency of electric pulse delivery reduces unpleasant sensations that occur in electrochemotherapy.

Involuntary muscle contractions and painful sensations during electric pulse delivery are the most unpleasant side effects of electrochemotherapy. The aim of this study was to determine the nature of pain caused by the application of electric pulses and to evaluate patients tolerance to the standard electric pulses of 1 Hz repetition frequency and the new 5 kHz protocol. A train of eight electric pulses of 1 Hz and 5 kHz repetition frequencies was delivered to the forearms of 40 healthy volunteers. After the conclusion of each protocol the subjects had to complete the short-form McGill Pain Questionnaire with separate visual analog scales for pain intensity and unpleasantness. All subjects selected at least one superficial and one deep pain descriptor; 85% selected at least two superficial descriptor and 60% at least two deep description. The application of 5 kHz electric pulses was less unpleasant than the standard 1 Hz pulses; however, the pain intensity did not differ between the protocols. Significantly more subjects chose the new 5 kHz protocol as their choice of treatment (P = 0.017). The frequent use of deep descriptors in our study indicates that muscle contractions contribute to the discomfort felt by the subjects during the delivery of electric pulses. The new 5 kHz protocol considerably shortens the treatment session and is also better tolerated. Therefore, the new 5 kHz electrochemotherapy protocol should eventually replace the 1 Hz pulses as new standard.