Abstract
The efficiency of electroporation (EP) has made it a widely used therapeutic procedure to transfer cell killing substances effectively to the target site. A lot of researches are being done on EP-based cancer treatment techniques. Electrochemotherapy (ECT) is the first EP-based application in the field of drug administration. ECT is a local and nonthermal treatment of cancer that combines the use of a medical device with pharmaceutical agents to obtain local tumor control in solid cancers. It involves the application of eight, 100µs, pulses at 1 or 5000 Hz frequency and specified electric field (V/cm) with a median duration of 25 minutes. The efficacy of chemotherapeutic drugs increases by applying short and intense electrical pulses. Several clinical studies proposed ECT as a safe and complementary curative or palliative treatment option (curative intent of 50% to 63% in the treatment of Basal Cell Carcinoma (BCC)) to treat a number of solid tumors and skin malignancies, which are not suitable for conventional treatments. It is used currently for treatment of cutaneous and subcutaneous lesions, without consideration of their histology. On the contrary, it is also becoming a practical method for treatment of internal, deep-seated tumors and tissues. A review of this method, needed instruments, alternative image-guided procedures (IGP) approaches, and future perspectives and recommendations are discussed in this paper.
Highlights
When a sufficiently large electric field is applied to a tissue for an adequate duration, transmembrane voltage is induced across the cell plasma membrane
The changes in the geometrical and material properties of the tissue cause local deficiencies in the cell membrane and make it permeable to agents that otherwise could not transfer into it. is phenomenon is usually known as electroporation (EP) [1, 2]. ere are two types of EP: reversible and irreversible. e duration of the pulses and electric field intensity determine whether the structural changes in the cell membrane are reversible, allowing cells to survive or irreversible, leading to cell death because of the loss of homeostasis [3]
Is phenomenon became a common technique for loading cells with materials that are either not possible or difficult to pass through the cells. is led to the growth of EP-based technology for biomedical applications and researches in the field of drug delivery and gene therapy, like gene electrotransfection, nonthermal irreversible electroporation, and electrochemotherapy (ECT) [4,5,6]. e effectiveness of these kinds of therapies depends on two factors: firstly, the electrical characteristics such as amplitude and duration of electric pulses, number of pulses and repetition, and the type of electrodes which are used and, secondly, cell and tissues characteristics, like shape, size, and cytoskeleton structure and membrane composition, that want to perform the EP on it [7, 8]
Summary
When a sufficiently large electric field is applied to a tissue for an adequate duration, transmembrane voltage is induced across the cell plasma membrane. ECT has been used in the treatment of subcutaneous and cutaneous lesions and metastases from tumors, with objective response ranging from 75% to 99% It is applied for treating melanomas, sarcomas, and other types of skin cancer, cervix leiomyosarcoma, and breast cancer. National Institute for Health and Care Excellence (NICE) in UK suggests ECT to manage inaccessible or otherwise difficult to treat primary Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC) in carefully selected patients It supports ECT use as a palliative treatment for metastases in the skin from tumors of nonskin origin and melanoma, with normal arrangements for clinical governance, consent, and audit. ECT has been known by some of national health services for the treatment of patients with cutaneous metastases from various tumor histotypes It has been adapted over 150 cancer centers throughout Europe and has contributed to its diffusion in clinical practice. Following a review of the ECT procedure in the terms of practical implementation and technical requirements, the new application of ECT, alternative Image-Guided Procedures (IGP) approaches, and what needs to be done for further application are discussed
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