Sarcoma and Melanoma Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy.
Radiol Oncol. 2013 Oct 8;47(4):370-5. doi: 10.2478/raon-2013-0051. eCollection 2013.
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.
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.
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.
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.
造口周围转移较为罕见，但可能与相关发病率有关。手术切除，随后进行造口移位，是大多数患者的金标准。我们描述电化学疗法（ECT），一种通过电脉冲局部增强药物递送的微创方法，作为一种替代方法。
一名 49 岁男性患有晚期胃癌，在肠造口部位周围出现皮肤转移。溃疡性渗出性肿瘤生长导致患者生活质量受损，因为造口袋的适配不断出现问题，其贴合度差，导致粪便溢出。ECT 在轻度全身镇静下进行 20 分钟。在经皮应用针电极进行多次 1.5 毫秒长的电脉冲之前，先给予博来霉素 15000IU/m2 的推注。
ECT 术后过程顺利，患者当天出院。一周后，肿瘤结节变平，一个月随访时可明显观察到部分肿瘤消退。更重要的是，造口周围的皮肤状况显著改善，从而在接下来的几个月中能够有效地应用造口袋，直到患者死亡。
本报告表明 ECT 作为一种微创方法治疗造口周围肿瘤的可行性。在选择的病例中，ECT 通过快速控制肿瘤，可确保有效的造口管理并维持患者的生活质量。
