What is electrochemotherapy?
Electrochemotherapy (sometimes called ECT) is a treatment for cancers that affect the skin such as breast cancer skin metastases. It’s a local treatment so it won’t treat any other areas of secondary breast cancer inside the body.
It combines a low dose of a chemotherapy drug and electrical impulses (called electroporation), which are given directly to the area(s) being treated using an electrode. Using electrical impulses allows the chemotherapy to work in the treated areas only, with little or no effect in other areas.
How does it work?
The dose of the chemotherapy drug is much lower than when it’s given to treat the whole body. This low dose of the chemotherapy drug isn’t effective in treating cancer cells when used alone. But, in electrochemotherapy the electrical impulses change the outer layer (membrane) of the cancer cells in the treated area by opening up gaps (pores) on their surface for a short time. This means that the chemotherapy drug can enter the cancer cells more easily. Once the pores close the chemotherapy is sealed inside the cells.
Because the overall dose of chemotherapy is low, people do not usually experience all the common side effects of chemotherapy, for example hair loss.
Many people only need a single treatment of electrochemotherapy. However, the procedure can be repeated in the same area if required or used to treat a different site.
Who can have electrochemotherapy?
Electrochemotherapy has been approved by the National Institute for Health and Care Excellence (NICE) as a treatment to relieve symptoms of cancers affecting the skin, including skin metastases.
Studies have shown that electrochemotherapy can help stop bleeding, ulceration (broken skin) and pain, and can reduce the size of the skin metastases. It may be used to treat skin metastases when other treatments haven’t worked or when surgery isn’t suitable. It can also be given alongside other treatments.
In some people it may also be used when the breast cancer has come back in the chest/breast area or in the skin near the original site or in the scar, but has not spread to other parts of the body (local recurrence).
Electrochemotherapy may also be used on some ulcerating breast cancers (sometimes called fungating wounds) to help reduce symptoms such as bleeding, oozing and odour (smell).
Some people with certain lung conditions may not be suitable for this treatment.
What happens during treatment?
For most people, the treatment can be carried out as an outpatient or day case. Some people may need to stay in hospital overnight depending on how much treatment is required and their general health.
As the treatment can be uncomfortable it is usually given under general anaesthetic but can sometimes be given under local anaesthetic, depending on the size of the area or how many areas need to be treated.
The chemotherapy is usually given into a vein (intravenously). It can also be given directly into the area of cancer being treated by injection (intratumourally). Bleomycin is the chemotherapy drug most commonly used for electrochemotherapy. Cisplatin (another chemotherapy drug) may also be used.
A short time after the chemotherapy drug is given, electric impulses are given directly to the area using an electrode with the help of a specially designed needle probe. The electrode may be applied a number of times to make sure the whole area is treated. The procedure usually takes about 30 minutes depending on the size of the area(s).
After the procedure, the area(s) will often be covered with a dressing that may need changing regularly. The treated areas will usually scab over. Often the areas look worse before any improvement is seen.
Like any treatment, electrochemotherapy can cause side effects. Everyone reacts differently to treatments and some people have more side effects than others.
The most common side effects are listed below.
You may have pain in the area of skin that was treated and it may feel warm. Pain is often mild but will vary from person to person. It’s usually temporary but may continue for a few weeks. Your doctor can prescribe pain relief to help with this. Pain may be worse for people who are already experiencing pain caused by skin metastases, or when particular areas are treated, for example, near the sternum (breastbone).
Some people have muscle contractions during the time that the electric impulses are being given. This usually stops once the treatment is finished but can cause a cramp-like discomfort for a short time after treatment.
It’s common to have increased skin pigmentation (colour) in the treated area (lighter or darker). This skin change appears one - two weeks after treatment and although it may fade is usually permanent.
Other less common side effects include:
- allergic reaction to the chemotherapy drug used
- bleeding and oozing from the wound
- mild temperature (usually resolves with paracetamol)
- mild rash
- redness and swelling
- lung problems due to the side effect of the chemotherapy.
Some people will have mild effects from the chemotherapy drug given, for example nausea and vomiting.
Electrochemotherapy is a relatively new treatment, but is now available in a number of hospitals in England, Scotland and Wales. If this is a suitable treatment option for you, your specialist team can refer you to the nearest available location for treatment.
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Graphic adapted from: Sersa et al.Electrochemotherapy in treatment of tumours. European Journal of Surgical Oncology. 2008. 34: 232–240. Adapted by permission under the Creative Commons Attribution-ShareAlike 3.0 license:creativecommons.org/licenses/by-sa/3.0.