Electrochemotherapy in radiotherapy-resistant epidural spinal cord compression in metastatic cancer patients

Frederic Deschamps; Lambros Tselikas; Steven Yevich; Baptiste Bonnet; Charles Roux; Adrian Kobe; Benjamin Besse; Kevin Berthelot; Amelie Gaudin; Lluis M Mir; Thierry de Baere

doi:10.1016/j.ejca.2023.03.012

Electrochemotherapy in radiotherapy-resistant epidural spinal cord compression in metastatic cancer patients

Eur J Cancer. 2023 Jun:186:62-68. doi: 10.1016/j.ejca.2023.03.012. Epub 2023 Mar 17.

Authors

Affiliations

¹ Department of Interventional Radiology, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805 Villejuif, France; Université Paris-Saclay, CNRS, Gustave Roussy, Aspects métaboliques et systémiques de l'oncogénèse pour de nouvelles approches thérapeutiques, 94805 Villejuif, France. Electronic address: Frederic.deschamps@gustaveroussy.fr.
² Department of Interventional Radiology, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805 Villejuif, France.
³ Department of Medical Oncology, International Center for Thoracic Cancers (CICT), Université Paris-Saclay, Gustave Roussy, 114 rue Edouard Vaillant, 94805 Villejuif, France.
⁴ Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805 Villejuif, France.
⁵ Department of Pharmacology, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805 Villejuif, France.
⁶ Université Paris-Saclay, CNRS, Gustave Roussy, Aspects métaboliques et systémiques de l'oncogénèse pour de nouvelles approches thérapeutiques, 94805 Villejuif, France.

PMID: 37030078
DOI: 10.1016/j.ejca.2023.03.012

Abstract

Objective: To report efficacy and safety of percutaneous electrochemotherapy (ECT) in patients with radiotherapy-resistant metastatic epidural spinal cord compression (MESCC).

Material/ methods: This retrospective study analyzed all consecutive patients treated with bleomycin-based ECT between February-2020 and September-2022 in a single tertiary referral cancer center. Changes in pain were evaluated with the Numerical Rating Score (NRS), in neurological deficit with the Neurological Deficit Scale, and changes in epidural spinal cord compression were evaluated with the epidural spinal cord compression scale (ESCCS) using an MRI.

Results: Forty consecutive solid tumour patients with previously radiated MESCC and no effective systemic treatment options were eligible. With a median follow-up of 5.1 months [1-19.1], toxicities were temporary acute radicular pain (25%), prolonged radicular hypoesthesia (10%), and paraplegia (7.5%). At 1 month, pain was significantly improved over baseline (median NRS: 1.0 [0-8] versus 7.0 [1.0-10], P < .001) and neurological benefits were considered as marked (28%), moderate (28%), stable (38%), or worse (8%). Three-month follow-up (21 patients) confirmed improved over baseline (median NRS: 2.0 [0-8] versus 6.0 [1.0-10], P < .001) and neurological benefits were considered as marked (38%), moderate (19%), stable (33.5%), and worse (9.5%). One-month post-treatment MRI (35 patients) demonstrated complete response in 46% of patients by ESCCS, partial response in 31%, stable disease in 23%, and no patients with progressive disease. Three-month post-treatment MRI (21 patients) demonstrated complete response in 28.5%, partial response in 38%, stable disease in 24%, and progressive disease in 9.5%.

Conclusions: This study provides the first evidence that ECT can rescue radiotherapy-resistant MESCC.

Keywords: Bone; Electrochemotherapy; Extramedullary Spinal Cord Compression; Legs; Metastasis; Palliative; Paralysis; Radiology; Spinal column; Therapy.

MeSH terms

Decompression, Surgical
Electrochemotherapy*
Humans
Neoplasms, Second Primary*
Pain
Retrospective Studies
Spinal Cord Compression* / diagnostic imaging
Spinal Cord Compression* / etiology
Spinal Cord Compression* / radiotherapy
Spinal Neoplasms* / secondary