title: Minimally invasive treatment of peristomal metastases from gastric cancer at an ileostomy site by electrochemotherapy.
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.
  
  
  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.
authors.affiliation: Sarcoma and Melanoma Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy.
authors.forename: Luca G
authors.initials: LG
authors.lastname: Campana
authors.forename: Marco
authors.initials: M
authors.lastname: Scarpa
authors.forename: Antonio
authors.initials: A
authors.lastname: Sommariva
authors.forename: Elena
authors.initials: E
authors.lastname: Bonandini
authors.forename: Sara
authors.initials: S
authors.lastname: Valpione
authors.forename: Leonardo
authors.initials: L
authors.lastname: Sartore
authors.forename: Carlo R
authors.initials: CR
authors.lastname: Rossi
keywords: electrochemotherapy; ileostomy; palliative care; skin care; stomach neoplasms