Electrochemotherapy to Metastatic Spinal Melanoma: A Novel Treatment of Spinal Metastasis?
METHODS
Preliminary report of new antitumor treatment.


OBJECTIVE
To evaluate the effectiveness of electrochemotherapy as a novel treatment of spinal metastasis.


BACKGROUND
Electrochemotherapy is a new antitumor treatment that combines systemic bleomycin with electric pulses delivered locally at the tumor site. These electric pulses permeabilize cell membranes in the tissue, allow bleomycin delivery diffusion inside the cells, and increase bleomycin cytotoxicity. Previous clinical studies have demonstrated the effectiveness of electrochemotherapy in the treatment of several primary and metastatic solid tumors.


METHODS
Treatment planning for electrode positioning and electrical pulse parameters was prepared for 4 needle electrodes. Mini-open surgery with a left L5 laminectomy was performed to introduce the eletrodes. The patient was treated according to the established Electrochemotherapy Protocol with Bleomycin. Clinical efficacy of electrochemotherapy was evaluated according to a visual analog scale of pain, Oswestry Disability Index 2.0, the Karnofsky Performance Scale, and Response Evaluation Criteria in Solid Tumors.


RESULTS
The assessed follow-up period was 48 months after the electrochemotherapy procedure. Neither serious electrochemotherapy-related adverse events, nor bleomycin toxicity were reported. Overall improvement in pain according to Oswestry Disability Index 2.0 and Karnofsky Performance Scale outcomes was better.


CONCLUSIONS
Our case represents, to our knowledge, the first one to test the potential role of electrochemotherapy as treatment of spinal metastasis. Electrochemotherapy allowed a successful treatment of metastatic spinal melanoma. However, we believe that there is a strong scientific rationale to support the potential utility of electrochemotherapy as a novel treatment of spinal metastasis, regardless of the histological types.


METHODS
5.
*Department of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Bologna, Italy†Department of Experimental Surgery, Codivilla-Putti Research Institute, Rizzoli Institute, Bologna, Italy.
Alessandro
A
Gasbarrini
Wuilker Knoner
WK
Campos
Laura
L
Campanacci
Stefano
S
Boriani
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001761:Bleomycin / Q000627:therapeutic use; D053672:Electrochemotherapy / Q000379:methods*; D005260:Female; D006801:Humans; D008545:Melanoma / Q000188:drug therapy* / Q000473:pathology*; D008875:Middle Aged; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D013125:Spinal Neoplasms / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery
D000970:Antineoplastic Agents; D001761:Bleomycin