Multiple brain metastases - current management and perspectives for treatment with electrochemotherapy

Abstract

<jats:p>Background. Due to the advanced oncological treatments of cancer, an overall increase in cancer incidence, and better diagnostic tools, the incidence of brain metastases is on the rise. This review addresses the current treatment options for patients with multiple brain metastases, presenting electrochemotherapy (ECT) as one of the new experimental treatments for this group of patients.</jats:p><jats:p>Conclusions. Neurosurgery, stereotactic surgery, and whole-brain radiotherapy are the evidence-based treatments that can be applied for patients with multiple brain metastases. Treatment with chemotherapy and molecularly targeted agents may also be warranted. Several experimental treatments are emerging, one of which is ECT, an effective cancer treatment comprising electric pulses given by electrodes in the tumor tissue, causing electroporation of the cell membrane, and thereby augmenting uptake and the cytotoxicity of the chemotherapeutic drug bleomycin by 300 times. Preclinical data are promising and the first patient has been treated in an ongoing clinical trial for patients with brain metastases. Perspectives for ECT in the brain include treatment of primary and secondary brain tumors as well as soft tissue metastases elsewhere.</jats:p>

In Vitro and In Vivo Experiments on Electrochemotherapy for Bladder Cancer

“…1,3 Novel electrodes were designed to use electrochemotherapy for brain tumors, 27 colorectal cancer, 28 bone 29 and liver 30 metastasis, soft tissue sarcoma, etc. The bladder is relatively easy to access.…”

Planning of Electroporation-Based Treatments Using Web-Based Treatment-Planning Software

“…The electric field is caused by high-voltage electric pulses that are delivered to the target tissue (i.e., tumor) using electrodes (Mir et al 1991). ECT is already used in clinical practice for treating metastases of skin melanoma in more than 100 clinical institutions in Europe ) and has already been introduced to clinical trials for treating deep-seated metastases in the liver (Edhemović et al 2011), brain (AgerholmLarsen et al 2011;Linnert et al 2012;Mahmood and Gehl 2011), bone (Fini et al 2011) and soft tissue (Neal et al 2011). While following standard operating procedures (Mir et al 2006) ensures safe and successful treatment of skin melanoma metastases (Marty et al 2006), patient-specific treatment planning is nevertheless required for ECT of deep-seated tumors (Pavliha et al 2012).…”

Operating Procedures of the Electrochemotherapy for Treatment of Tumor in Dogs and Cats

“…However, the configuration of the electrodes is a technological feature that is fast developing and now different sets of electrodes are used for specific administrations long-needle single electrodes for metastases of colorectal tumors in the liver 25 , bone metastases 7 , soft tissue sarcoma 26 , endoluminal electrodes for colorectal, gastric and esophageal tumors 27 and expandable ''umbrella'' type electrodes for brain tumors 8 .…”

“…Additionally, ECT is used in several clinical studies treating tumor metastases in the brain 8 , bone 9 and liver 10 . Clinical studies in veterinary oncology have already demonstrated that ECT treatment results in up to 80% longlasting objective responses when treating cutaneous and subcutaneous tumors in dogs 11,12 , cats 13 and horses 14 .…”