Electrochemotherapy | North Bristol NHS Trust

What is Electrochemotherapy?

Electrochemotherapy is a therapeutic option for patients with locally spread cancer. It is a treatment combining a low dose of a chemotherapy drug (Bleomycin), which is injected into the tumour or into a vein (intravenously), and an electrical pulse (electroporation) is applied directly to the cancer cells using an electrode.

NICE published guidance on Electrochemotherapy in 2013, saying that it may reduce symptoms and improve quality of life for appropriately selected patients.

What type of cancer can be treated?

Electrochemotherapy is used to treat cancers that have spread (metastasised) from the original cancer site to the skin or just below the skin’s surface (subcutaneous) from the following types of cancer:

All skin cancer (melanoma & non-melanoma)
Breast cancer recurrence
Head and neck cancer, including oral cancer which has spread to the skin
Kaposi’s sarcoma and Angiosarcoma

Electrochemotherapy has the advantage of preserving healthy tissue when compared to other treatment options. It can also be used to shrink large cancers making them easier to remove surgically. As the chemotherapy drug is most active against the cancer cells, the normal tissue is unaffected.

Are there any alternatives?

Most patients referred for electrochemotherapy will already have had extensive surgery and/or chemotherapy. For these patients there may be no alternative treatment. Alternative treatment options such as surgery, radiotherapy, or chemotherapy will have been discussed with you by your Consultant before electrochemotherapy is offered.

What happens before treatment?

The areas to be treated are measured and photographed so that we can check your response to the treatment. If you give your permission, this data is uploaded to a secure database so it can be shared with other electrochemotherapy practitioners.

You can expect to receive the following appointments prior to your procedure:

A Pre-operative Assessment. Some baseline tests will be done at this appointment to ensure that anaesthetic is suitable for you.
A Lung Function Test (LFT) to assess that your lungs are healthy.
An appointment with an Oncologist who will check that you are suitable for chemotherapy; the Bleomycin will be prescribed following this review.

What happens on the day of treatment?

On the day of the treatment, you will present to the Admission Lounge. From there you will be taken up to Medirooms where you will meet your Consultant and Anaesthetist. You will be asked to sign a consent form for the treatment, will be marked again by your Consultant and then asked to change into a hospital gown. You will then be taken into the theatre suite where you will be given a general anaesthetic which means you will be asleep throughout the procedure.

What happens during the treatment?

The chemotherapy drug is usually transmitted into a vein and after a short period, a probe is inserted into the cancer which releases a small electrical current. This electrical current opens up pores in the cells allowing the drug to enter and destroy the cancer cells.

How long will I stay in hospital?

The procedure can be carried out as a day case (you can go home the same day), but hospital stays will vary from patient to patient depending on your general health.

Will I need pain relief?

Most people tolerate the therapy well with minimal post treatment pain, but pain levels do vary from patient to patient. You will be prescribed pain relief to take home with you.

What happens after treatment?

You will go home with small dressings over the areas treated with electrochemotherapy. These can be removed within 2 days and you can shower using simple soap to wash the areas and then pat dry using kitchen paper towel. If the areas are still weeping fluid, you can cover the areas with simple dressings. If the area is dry you can go without dressings and apply a simple moisturiser.

Often the areas turn black and scab over. This is a normal part of the healing process and may look worse before it starts to get better; it usually improves over a few weeks. The skin in the area may become darker or sometimes lighter and this might be permanent.

What are the risks and side-effects?

Some patients may experience mild nausea or vomiting following the treatment, but anti-sickness medication can be prescribed to relieve this. Rarely, the wound site may become infected. Signs to look out for around the wound site include: - increased redness and pain, discharge or fluid leakage, a high temperature.

If you are concerned about these symptoms you should contact your GP or hospital medical team. Serious side-effects are extremely rare but, as with all medical interventions, can happen. In very few cases patients may have an allergic reaction to the chemotherapy drug or may experience shortness of breath.

The Bleomycin drug used for electrochemotherapy can cause permanent stiffening of the lungs (fibrosis). This may cause shortness of breath which will need treatment immediately. If this isn’t managed well, it could lead to needing oxygen long term or, rarely, breathing problems resulting in death. This is why it is important to have any relevant investigations and lung function tests before any electrochemotherapy treatment.

Will I need more than one treatment?

Electrochemotherapy can be repeated as necessary after a minimum of 4 weeks to improve the response to the treatment or to control any new cancer nodules that appear.

References and further information

www.igeamedical.co.uk/patients

The National Institute for Health and Care Excellence (NICE) has published the following guidelines on electrochemotherapy: www.nice.org.uk/guidance/ipg446

How to contact us:

Lynda Knowles
Joanne Watson
Claire Lanfear
Samantha Wells
Tel: 0117 414 7415

Further Information: www.cancerresearchuk.org

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.