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

Campana LG, Scarpa M, Sommariva A, Bonandini E, Valpione S, Sartore L, Rossi CR - Radiol Oncol (2013)

Bottom Line: Post 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.This report suggests the feasibility of ECT as a minimally invasive approach for peristomal tumors.

View Article: PubMed Central - PubMed

Affiliation: Sarcoma and Melanoma Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy.

ABSTRACT

Background: Peristomal 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 methods: A 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/m(2) was followed by the percutaneous application of multiple, 1.5 ms -long electric pulses by means of a needle electrode.

Results: Post 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.

Conclusions: This 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.

No MeSH data available.


Related in: MedlinePlus

Electrochemotherapy of peristomal skin metastases. Eight minutes after intravenous injection, bleomycin molecules are equally distributed in body tissues. Tumor nodules are briefly exposed to a train of eight consecutive, high voltage (1000 V/cm), square-wave, 100-ms electric pulses, delivered at a repetition frequency of 5000 Hz by means of a needle electrode inserted into tumor tissue and connected to a pulse generator. As a consequence, transient pores open on the cell membrane and enable bleomycin concentration and entrapment, thus increasing its cytotoxic activity.
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f1-rado-47-04-370: Electrochemotherapy of peristomal skin metastases. Eight minutes after intravenous injection, bleomycin molecules are equally distributed in body tissues. Tumor nodules are briefly exposed to a train of eight consecutive, high voltage (1000 V/cm), square-wave, 100-ms electric pulses, delivered at a repetition frequency of 5000 Hz by means of a needle electrode inserted into tumor tissue and connected to a pulse generator. As a consequence, transient pores open on the cell membrane and enable bleomycin concentration and entrapment, thus increasing its cytotoxic activity.

Mentions: Despite the introduction of combined treatment strategies, gastric cancer (GC) remains one of the leading causes of cancer-related death worldwide.1 The most common metastatic sites are lymph nodes, liver, ovary and peritoneal cavity. The occurrence of skin metastases is a rare event, generally found at a very late stage of disease 2–4 and, occasionally, as the initial clinical manifestation.5–8 Isolated superficial metastases have been also described following invasive procedures (i.e. laparoscopic surgery).9,10 Peristomal metastases represent an even rarer, but challenging finding, due to possible bowel obstruction and trouble in ostomy management. Wide local excision and stoma relocation, when feasible, represent the gold standard treatment for these patients. Unfortunately, only few of them are still considered resectable when skin metastases occur, due to disease extension and poor general conditions. Electrochemotherapy (ECT) is a minimally-invasive approach which is gaining increasing acceptance in patients with unresectable or refractory superficial metastases, thanks to its sustained antitumor activity in different tumor histotypes, rapid patient’s recovery and favorable short-term outcomes.11,12 ECT mechanism relies on the association of an anticancer agent, bleomycin (BLM) or cisplatin (CDDP), with transient tumor permeabilization by means of brief, high-voltage, electric pulses (electroporation).13 The drug can be administered as an intravenous bolus or, alternatively, by the intratumoral route, according to disease burden.14 Tumor electroporation is achieved by the application of suitable plate or needle electrodes. Electric pulses open multiple, reversible pores on cell membrane, throughout which an increased number of chemotherapy molecules entry into the cell and exert their selective cytotoxic activity (Figure 1). We here report on the first case featuring ECT as an alternative treatment in a patient with symptomatic skin metastases from GC at an ileostomy site.


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

Campana LG, Scarpa M, Sommariva A, Bonandini E, Valpione S, Sartore L, Rossi CR - Radiol Oncol (2013)

Electrochemotherapy of peristomal skin metastases. Eight minutes after intravenous injection, bleomycin molecules are equally distributed in body tissues. Tumor nodules are briefly exposed to a train of eight consecutive, high voltage (1000 V/cm), square-wave, 100-ms electric pulses, delivered at a repetition frequency of 5000 Hz by means of a needle electrode inserted into tumor tissue and connected to a pulse generator. As a consequence, transient pores open on the cell membrane and enable bleomycin concentration and entrapment, thus increasing its cytotoxic activity.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3814282&req=5

f1-rado-47-04-370: Electrochemotherapy of peristomal skin metastases. Eight minutes after intravenous injection, bleomycin molecules are equally distributed in body tissues. Tumor nodules are briefly exposed to a train of eight consecutive, high voltage (1000 V/cm), square-wave, 100-ms electric pulses, delivered at a repetition frequency of 5000 Hz by means of a needle electrode inserted into tumor tissue and connected to a pulse generator. As a consequence, transient pores open on the cell membrane and enable bleomycin concentration and entrapment, thus increasing its cytotoxic activity.
Mentions: Despite the introduction of combined treatment strategies, gastric cancer (GC) remains one of the leading causes of cancer-related death worldwide.1 The most common metastatic sites are lymph nodes, liver, ovary and peritoneal cavity. The occurrence of skin metastases is a rare event, generally found at a very late stage of disease 2–4 and, occasionally, as the initial clinical manifestation.5–8 Isolated superficial metastases have been also described following invasive procedures (i.e. laparoscopic surgery).9,10 Peristomal metastases represent an even rarer, but challenging finding, due to possible bowel obstruction and trouble in ostomy management. Wide local excision and stoma relocation, when feasible, represent the gold standard treatment for these patients. Unfortunately, only few of them are still considered resectable when skin metastases occur, due to disease extension and poor general conditions. Electrochemotherapy (ECT) is a minimally-invasive approach which is gaining increasing acceptance in patients with unresectable or refractory superficial metastases, thanks to its sustained antitumor activity in different tumor histotypes, rapid patient’s recovery and favorable short-term outcomes.11,12 ECT mechanism relies on the association of an anticancer agent, bleomycin (BLM) or cisplatin (CDDP), with transient tumor permeabilization by means of brief, high-voltage, electric pulses (electroporation).13 The drug can be administered as an intravenous bolus or, alternatively, by the intratumoral route, according to disease burden.14 Tumor electroporation is achieved by the application of suitable plate or needle electrodes. Electric pulses open multiple, reversible pores on cell membrane, throughout which an increased number of chemotherapy molecules entry into the cell and exert their selective cytotoxic activity (Figure 1). We here report on the first case featuring ECT as an alternative treatment in a patient with symptomatic skin metastases from GC at an ileostomy site.

Bottom Line: Post 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.This report suggests the feasibility of ECT as a minimally invasive approach for peristomal tumors.

View Article: PubMed Central - PubMed

Affiliation: Sarcoma and Melanoma Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy.

ABSTRACT

Background: Peristomal 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 methods: A 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/m(2) was followed by the percutaneous application of multiple, 1.5 ms -long electric pulses by means of a needle electrode.

Results: Post 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.

Conclusions: This 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.

No MeSH data available.


Related in: MedlinePlus