Electrochemotherapy (ECT) – The gentle alternative treatment method when everything else failed.
The finding of tumor recurrence or metastases, especially after surgical removal of the prostate (radical prostatectomy) is shocking news for patients and relatives. The return of the cancer is also called "biochemical relapse", because it is detected by a recurring rise in the PSA level. Since it is usually unclear at this point where exactly the recurrence is located and a new operation is not possible, the entire “prostate bed”, i.e. the location where the prostate was removed including the surrounding tissue, is often treated with radiation therapy.
However, radiation therapy leads to irreversible damage to the treated tissues and organs. This causes chronic irritation of the bladder and rectum, but also incontinence or other functional disorders. Radiation therapy also triggers chronic inflammation, scarring and genetic damage, which in turn can trigger cancer. Although radiation therapy is no guarantee of a cure for prostate cancer and this can occur again afterwards, repeated radiation is not possible because irreparable damage will occur if the maximum dose is exceeded.
Radiation therapy is at best a stopgap solution.
Electrochemotherapy (ECT), however, opens up new possibilities in the treatment of complex and advanced tumors - in a gentle way.
ECT has been established for several types of advanced cancer: with thousands of patients treated in more than 100 medical facilities worldwide, ECT is by now a well-known practice for treating a variety of cancers that fail conventional procedures. ECT is minimally invasive, in most cases painless and in usually only needs to be applied once.
The Clinical ESOPE studies have shown that 74% of treated tumor lesions were completely and 11% partially removed with a single application of ECT to skin metastases. Furthermore, no significant side effects have been reported following ECT treatment. Evidence of local recurrence was extremely rare.
The application of Electrochemotherapy for prostate cancer and prostate cancer recurrences and metastasis is a new approach to effectively and gently treat cancer, with initial data showing very low side effects. ECT can also be used in cases where conventional procedures such as surgery, radiation or chemotherapy are too dangerous or have shown to be ineffective. This will benefit in particular patients with advanced primary tumors and complex tumor recurrences, in which surrounding organs, vessels and nerves must be spared. ECT has a significantly shorter duration of treatment and avoids postoperative pain.
How does electrochemotherapy (ECT) work?
Electroporation is a physical process that renders the walls of cells (cell membranes) within the treatment field permeable by short electrical currents (current pulses). Depending on the number and strength of the current pulses, the cell membranes become temporarily (reversibly) or permanently (irreversibly) permeable. In the Nanoknife® treatment, cell membranes in the treatment field become irreversibly permeable (hence the term irreversible electroporation, IRE) and thus die. For this very high electric field strengths are necessary, which limit the size of the treatment field. However, the treatment field of the IRE is surrounded by a broad zone in which a reversible electroporation takes place: Here, the cell membranes open temporarily and then close again. The transient pore formation in the cell membranes in this area facilitates the uptake of drugs (and other large molecular substances such as genes). Even chemotherapeutic agents that otherwise can not penetrate cancer cells poorly are taken up by the cancer cells in this area of reversible electroporation.
The chemotherapeutic penetrates poorly into normal cells and therefore hardly damages them. In the treatment field of reversible electroporation, however, it can easily penetrate the permeabilized cell walls, so that an up to 10,000-fold higher efficiency is achieved and the cells die off. As a result, chemotherapy is focused on the treatment field, the tumor is damaged to the maximum and the rest of the body is spared.
The concept of electrochemotherapy: (a) the chemotherapeutic is located outside the cancer cell after injection (b) The cell membrane is perforated by electroporation allowing chemotherapeutic to invade (c) Membrane closes again, chemotherapeutic remains in the cell (d) As a result, it can damage the DNA, ultimately causing the cell to die.1
For electrochemotherapy, the chemotherapeutic is administered intravenously in relatively low dose. Typical chemotherapy side effects such as nausea and hair loss are thereby avoided. Also, the application is only once. Repetitions for longer periods, such as typical chemotherapy, are not required.
Treatment with ECT usually takes a maximum of two to three hours in most cases. It is performed under general anesthesia and wound pain does not occur. After an overnight hospital stay for observation, patients can return to their everyday live the next day without any impairment.
For whom is electrochemotherapy suitable?
ECT is an effective and gentle method of fighting cancerous tumors. It is particularly useful when the tumor is located near sensitive anatomical structures and when other procedures, such as surgery or radiotherapy, can no longer be used. As with all other medical procedures, a cure can not be guaranteed with this novel method, which is still experimental for some applications. Nevertheless, ECT, as an individual cure, is an extremely promising form of therapy that opens up new treatment options, especially for complex situations that were previously untreatable.
In our institute, we currently treat the following patient groups:
- Patients with bone metastases: More information on the curative and palliative treatment of bone metastases using ECT can be found here.
- Patients with lymph node metastases: Read more about the curative and palliative treatment of lymph node metastases using ECT.
- Patients with prostate carcinoma and carcinoma recurrence: IRE with electrochemotherapy (IRECT) of the prostate - A gentle treatment option for advanced carcinomas and complex recurrent tumors.
- In some cases patients with tumors in other organs: Write us or call us to find out [Link to Contact page], if ECT is suitable for treating your condition.
Whether the therapy is for you, our senior doctors judge after a thorough assessment of your case. For this we need your medical records, especially all imaging examinations (CT, MRI, PET, etc.). If necessary, new recordings are required as part of a re-staging.
Take your chance for a non-binding consultation by our experts. For more information please contact us.
1. Miklavcic D, Sersa G, Brecelj E, et al. Electrochemotherapy : technological advancements for efficient electroporation-based treatment of internal tumors. Med Biol Eng Comput. 2012. doi:10.1007/s11517-012-0991-8.