Electrochemotherapy in large and deep-seated soft tissue sarcomas: a pilot study on tumor control, limb preservation, and symptom relief
Abstract
Electrochemotherapy (ECT) is a locoregional treatment that combines reversible electroporation with chemotherapy to enhance intracellular drug delivery. Clinical evidence for ECT in large, deep-seated, recurrent, or locally advanced soft tissue tumors remains limited. This pilot study primarily evaluated symptom palliation following bleomycin-based ECT, with objective tumor response and treatment-related toxicity assessed as secondary outcomes. Twenty-five patients with recurrent, locally advanced, or metastatic STS tumors resistant to conventional treatments underwent ECT between 2022 and 2025. Bleomycin (15,000 IU/m²) was administered intravenously, followed by electroporation using variable electrode configurations according to tumor characteristics. The primary outcome was symptom palliation. Secondary outcomes included objective tumor response and treatment-related toxicity, while additional clinical outcomes included quality-of-life changes, limb preservation, local progression-free survival (LPFS), and overall survival (OS). The study population had a median tumor size of 87 mm (range 35–320 mm), and 92% of tumors were ≥ 5 cm. Overall symptom palliation was achieved in 16 of 18 symptomatic patients (88.9%), with pain reduction reported in 12 of 14 patients with severe baseline pain (85.7%) and complete cessation of bleeding and tumor-associated discharge in all eight affected patients. EORTC QLQ-C30 scores improved across all evaluated domains, including Global Health, Physical Function, and Role Function, while Pain and Other Symptoms scores decreased significantly (all P < 0.001). ECT enabled conversion to operability in selected unresectable tumors, and long-term limb preservation was achieved in four of the six patients who were initially considered candidates for amputation. An objective response was observed in 21/25 patients (84.0%, 95% CI: 63.9%–95.5%). After a median follow-up of 13.7 months, the 1-year LPFS and OS rates were 56.0% and 76.0%, respectively. The most frequent adverse events were skin reactions and soft tissue necrosis, which were generally manageable with conservative wound care or outpatient debridement. No serious ECT-related systemic adverse events were reported. ECT was associated with symptom palliation, objective tumor response, and manageable treatment-related toxicity in this pilot cohort. These preliminary findings warrant further evaluation in larger prospective controlled studies. Clinical trial registration number: The clinical trial registration code number was (IRCT20190904044697N8, Registration Date: 2022-10-02).
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BibTeX
@article{ghale2026electrochemotherapy,
title = {{Electrochemotherapy in large and deep-seated soft tissue sarcomas: a pilot study on tumor control, limb preservation, and symptom relief}},
author = {Hassan Younesi Ghale and Habibollah Mahmoodzadeh and Mahdis Bayat and Edris Berhanegard and Sepideh Mansouri and Alireza Naamvari and Alireza Mohamadian and Hossein Ghanaati and Seyed Rouhollah Miri and Mohammad Abdolahad},
journal = {Scientific Reports},
year = {2026},
month = oct,
doi = {10.1038/s41598-026-73029-1},
url = {https://www.nature.com/articles/s41598-026-73029-1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Electrochemotherapy in large and deep-seated soft tissue sarcomas: a pilot study on tumor control, limb preservation, and symptom relief
AU - Hassan Younesi Ghale
AU - Habibollah Mahmoodzadeh
AU - Mahdis Bayat
AU - Edris Berhanegard
AU - Sepideh Mansouri
AU - Alireza Naamvari
AU - Alireza Mohamadian
AU - Hossein Ghanaati
AU - Seyed Rouhollah Miri
AU - Mohammad Abdolahad
PY - 2026
DA - 2026/10/22
JO - Scientific Reports
DO - 10.1038/s41598-026-73029-1
UR - https://www.nature.com/articles/s41598-026-73029-1
AB - Electrochemotherapy (ECT) is a locoregional treatment that combines reversible electroporation with chemotherapy to enhance intracellular drug delivery. Clinical evidence for ECT in large, deep-seated, recurrent, or locally advanced soft tissue tumors remains limited. This pilot study primarily evaluated symptom palliation following bleomycin-based ECT, with objective tumor response and treatment-related toxicity assessed as secondary outcomes. Twenty-five patients with recurrent, locally advanced, or metastatic STS tumors resistant to conventional treatments underwent ECT between 2022 and 2025. Bleomycin (15,000 IU/m²) was administered intravenously, followed by electroporation using variable electrode configurations according to tumor characteristics. The primary outcome was symptom palliation. Secondary outcomes included objective tumor response and treatment-related toxicity, while additional clinical outcomes included quality-of-life changes, limb preservation, local progression-free survival (LPFS), and overall survival (OS). The study population had a median tumor size of 87 mm (range 35–320 mm), and 92% of tumors were ≥ 5 cm. Overall symptom palliation was achieved in 16 of 18 symptomatic patients (88.9%), with pain reduction reported in 12 of 14 patients with severe baseline pain (85.7%) and complete cessation of bleeding and tumor-associated discharge in all eight affected patients. EORTC QLQ-C30 scores improved across all evaluated domains, including Global Health, Physical Function, and Role Function, while Pain and Other Symptoms scores decreased significantly (all P < 0.001). ECT enabled conversion to operability in selected unresectable tumors, and long-term limb preservation was achieved in four of the six patients who were initially considered candidates for amputation. An objective response was observed in 21/25 patients (84.0%, 95% CI: 63.9%–95.5%). After a median follow-up of 13.7 months, the 1-year LPFS and OS rates were 56.0% and 76.0%, respectively. The most frequent adverse events were skin reactions and soft tissue necrosis, which were generally manageable with conservative wound care or outpatient debridement. No serious ECT-related systemic adverse events were reported. ECT was associated with symptom palliation, objective tumor response, and manageable treatment-related toxicity in this pilot cohort. These preliminary findings warrant further evaluation in larger prospective controlled studies. Clinical trial registration number: The clinical trial registration code number was (IRCT20190904044697N8, Registration Date: 2022-10-02).
SN - 2045-2322
ER -