The promises - and limits - of electrochemotherapy

Written by: Mr Alastair MacKenzie Ross
Published: | Updated: 13/02/2020
Edited by: Nicholas Howley

Electrochemotherapy (ECT) is a new cancer treatment for tumours on the skin. It has fewer side effects than traditional chemotherapy and it’s a quick procedure – so why isn’t it widely practised yet? Consultant plastic surgeon Mr Alastair MacKenzie-Ross explains how ECT works and the challenges of rolling out a new treatment for cancer.

Electrochemotherapy is a treatment for cancerous tumours on the skin.

How does electrochemotherapy work?

Electrochemotherapy is a treatment which is aimed at tumours on the skin. The procedure involves sending a pulse of electricity to the target tumour to “open up” the cancer cells and make them more permeable to chemotherapy. The cells then “close” again, trapping the chemotherapy inside, which goes on to kill the cells.

What makes it different to other kinds of cancer treatment?

Electrochemotherapy uses a much lower dosage of the chemotherapy drug than conventional chemotherapy treatment, and is much more localised, only delivering the drug to the target cells.

The procedure is very short – only taking about 45 minutes, although your total hospital stay will be longer. Unlike radiotherapy, electrochemotherapy can be administered multiple times if the initial procedure does not eliminate all of the tumour.

Most of the time the side effects are quite minimal – there are small marks where the needles have pierced the skin, and you might get short-term or long-term pain from nerve cells stimulated by electricity. There is also a risk of bleeding, so this treatment might not be recommended if you need to take anticoagulants.

What is it currently used for?

Electrochemotherapy be used to treat some types of primary skin cancer, including basal cell carcinoma and squamous cell carcinoma. In particular, ECT has been used around the mouth in order to preserve tissue and function.

At the moment, it’s mainly used to treat metastases to the skin from other types of cancer, the most common being breast cancer. This is usually a palliative measure, where other types of treatment have failed, in order to reduce the pain and discomfort from the tumour.

What are the current barriers to wider use?

At the moment only a few thousand patients have been treated with electrochemotherapy and its use is limited to just a few clinics in the UK.

There are two main reasons for this. First, the treatment involves new technology which very few clinics currently possess, and it needs to be delivered by a multidisciplinary team. So there are technical and organisational barriers which we need to overcome.

Secondly, since it’s a relatively young treatment, we haven’t yet collected enough data to understand the long-term outcomes of this treatment. Until we know how effective the treatment is in the long term, we can’t be sure that it offers the same improvements to lifespan as other treatment options. We do know, though, that it is a safe treatment. It is endorsed by the National Institute for Health and Care Excellence (NICE).

So on the whole, it may be some time before we see wide use of electrochemotherapy. That being said, the early results are promising – and it will be interesting to see how research on this treatment evolves in the future.

By Mr Alastair MacKenzie Ross
Plastic surgery

Mr Alastair MacKenzie Ross is one of London's leading consultant plastic surgeons. He specialises in skin cancer (including melanoma), electrochemotherapy, reconstruction and scars.

Mr Mackenzie Ross qualified in medicine from the University of Cambridge in 1996 and went on to complete his higher surgical training in London. He undertook a hand surgery fellowship in Singapore in 2010 and the following year returned to London to complete a cosmetic reconstructive surgery interface fellowship. In 2012, he was awarded a further prestigious fellowship in melanoma and surgical oncology at the Melanoma Institute Australia. He is a core member of the multi-disciplinary teams for melanoma and non-melanoma cancer at Guy's and St Thomas' Hospitals, and a founding member of the multi-disciplinary skin cancer team at the Wellington Hospital. Additional to his work within the NHS, Mr MacKenzie Ross sees private patients at the OneWelbeck clinic.

Mr Mackenzie Ross’ many years of clinical experience along with his strong academic background make him a leading expert in the field of plastic surgery. He was formerly the surgical lead for the London Cancer Alliance Skin Cancer Pathway Group and has teaching and training responsibilities in his role of clinical supervisor within Guy’s and St Thomas’ Hospitals. His academic work is widely published in peer-reviewed journals.

In keeping with best practice, skin cancer patients under Mr MacKenzie Ross’ care are managed with the benefit of input from the whole multi-disciplinary team. Electrochemotherapy is at the cutting-edge of cancer management and Mr MacKenzie Ross is one of the first to offer this treatment privately in London.

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