Treatment of Lymph Node Metastases from Gastric Cancer with a Combination of Irreversible Electroporation and Electrochemotherapy
Gastric cancer ranks among the most prevalent cancers of the digestive system worldwide, often diagnosed at advanced stages. According to global statistics, it is the second leading cause of cancer-related mortality, with a high recurrence rate even after successful surgical interventions. Lymph node metastases pose a significant challenge in treating these patients, as they are frequently located near critical structures such as blood vessels and nerves. Conventional treatments like surgery, systemic chemotherapy, or radiotherapy often come with severe side effects. In recent years, innovative approaches such as Electrochemotherapy (ECT) and Irreversible Electroporation (IRE) have emerged as minimally invasive options for local tumor control. The combination of these two methods, known as IRECT, has shown remarkable potential in managing lymph node metastases.
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Electrochemotherapy and Irreversible Electroporation
Electrochemotherapy (ECT) is a therapeutic approach that combines a specific chemotherapeutic agent, such as bleomycin or cisplatin, with a targeted intracellular delivery mechanism using a high-intensity pulsed electric field. This field temporarily increases cell membrane permeability (reversible electroporation), significantly enhancing the cytotoxicity of the administered drug.
Irreversible Electroporation (IRE), on the other hand, induces permanent damage to cell membranes through high-voltage electrical pulses, leading to apoptotic cell death without causing thermal injury to surrounding tissues. The integration of IRE and ECT, referred to as IRECT, expands the treatment area, allowing chemotherapeutic drugs to penetrate the tumor’s peripheral cells while preserving vital anatomical structures.
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History and Development of ECT and IRE
Initial laboratory studies on ECT date back over 20 years, followed by numerous rigorous clinical trials, particularly for treating cutaneous and subcutaneous tumors, as well as deep-seated tumors. Over the past decade, ECT has been successfully employed for managing cutaneous and subcutaneous tumors, primarily melanoma. In recent years, research has extended to the application of ECT in deep-seated tumors. IRE was introduced in the early 2010s as a non-thermal ablation technique and has been utilized in treating tumors of the liver, pancreas, and prostate.
Current reports indicate that these therapies have been highly effective in managing gastrointestinal tumors. For instance, studies on pancreatic tumor treatment with ECT reported no serious acute (intraoperative) or postoperative adverse effects. No clinically significant biological changes were observed in electrocardiography, hemodynamics, or serum markers. There were no notable increases in amylase or lipase levels, nor any instances of bleeding or damage to surrounding organs.
In 2024 and 2025, significant advancements were reported in the use of ECT for deep-seated tumors. A 2024 systematic review demonstrated that ECT improved local tumor control, reduced pain, and enhanced quality of life in 43 patients with pancreatic cancer, with mild to moderate adverse effects (91.7% Clavien-Dindo grade I-II). Additionally, 2025 studies on high-frequency ECT highlighted reduced pain and improved efficacy in treating resistant cancers, with an emphasis on combining it with immunotherapy for systemic effects.
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Mechanism of Action of IRE and ECT
ECT relies on reversible electroporation, where short electrical pulses (100 microseconds) temporarily permeabilize cell membranes, facilitating the entry of chemotherapeutic drugs. This process can increase drug cytotoxicity by up to 1,000 times and induces a “vascular lock” effect, reducing tumor blood flow and preventing drug washout.
In contrast, IRE employs stronger pulses (up to 3,000 volts) to cause irreversible membrane damage and cell death, sparing non-cellular structures like blood vessels and bile ducts. The IRECT combination allows IRE to destroy the tumor core while ECT targets the margins with enhanced drug delivery. This approach is particularly effective for tumors near critical structures, such as abdominal lymph nodes, as it avoids thermal damage and minimizes risks to blood vessels or nerves.
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Application in Gastric Cancer and Lymph Node Metastases
Gastric cancer is frequently associated with lymph node metastases, which complicates treatment. Recent studies indicate that ECT is effective in gastrointestinal cancers, such as colorectal and pancreatic cancers, achieving complete response rates of up to 100% in hepatic metastases. For lymph node metastases from gastric cancer, the IRECT approach holds significant promise.
A pivotal 2017 case report described the treatment of a 57-year-old woman with para-aortic and pericaval lymph node metastases. Following neoadjuvant chemotherapy and gastrectomy, the patient experienced recurrence. IRECT was performed using bleomycin (23 mg) and electrical pulses (up to 3,000 volts). The treatment resulted in no major complications, mild pain (VAS 1-2), and imaging at eight months revealed connective tissue with no malignancy.
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[The image below illustrates the patient’s treatment outcome six weeks after electrochemotherapy in the gastric region.]
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In 2024, a study involving 19 patients with lymph node metastases, including those from gastric cancer, confirmed IRE’s safety, with a 100% technical success rate and tumor size reduction in 83.3% of cases. Mild adverse effects were reported in 21.1% of cases, with a median local progression-free survival of 24.1 months. Studies in 2025 underscored the potential of combining IRE with immunotherapy, enhancing systemic effects and improving survival rates.
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Comparison with Other Treatment Modalities
The IRECT approach offers significant advantages over traditional treatments such as surgery, systemic chemotherapy, and radiotherapy. Surgery for lymph node metastases in gastric cancer is often complex and high-risk, potentially damaging critical structures like large blood vessels and leading to postoperative complications such as bleeding, infection, and extended recovery periods. In contrast, IRECT is minimally invasive, performed percutaneously with electrodes, eliminating the need for large incisions and preserving surrounding structures.
Systemic chemotherapy, which distributes drugs throughout the body, is often associated with severe side effects, including nausea, hair loss, immune suppression, and drug resistance. ECT, by enhancing localized drug cytotoxicity (up to 1,000 times) with lower doses, minimizes these side effects and reduces systemic impact. Radiotherapy, meanwhile, can harm healthy surrounding tissues, leading to long-term complications like fibrosis or gastrointestinal issues, whereas IRE’s non-thermal nature avoids the “heat sink effect,” making it effective for vascular tumors.
However, IRECT may be less suitable for very large or diffuse tumors and requires specialized equipment. Studies indicate that ECT achieves complete response rates of 55-100% for gastrointestinal cancers, compared to systemic chemotherapy’s lower overall survival rates (11-24 months). Ultimately, IRECT serves as a complementary option that enhances quality of life and can be combined with other therapies.
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Advantages and Adverse Effects
IRECT’s benefits include its minimally invasive nature, preservation of vital structures, repeatability, and compatibility with other treatments. Adverse effects are generally mild, such as muscle pain or edema, with no hemodynamic changes or damage to surrounding organs. Studies report severe adverse effect rates below 3%.
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Pars Tarava: Pioneering ECT and IRE in Iran
Pars Tarava, Iran’s leading manufacturer of advanced electroporation and electrochemotherapy devices, has made these cutting-edge treatments accessible, cost-effective, and safe for Iranian patients. As the first domestic producer of such equipment, Pars Tarava plays a pivotal role in elevating oncologic care in the country, adhering to global quality standards and providing comprehensive support to physicians and patients.
Pars Tarava’s user-friendly and technologically advanced devices enable clinicians to deliver tailored treatments, yielding superior outcomes for patients. For specialized consultations, device information, or treatment planning, contact Pars Tarava’s expert team at +98 902 405 1862.
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Conclusion
The integration of IRE and ECT represents a groundbreaking advancement in treating lymph node metastases from gastric cancer, supported by robust clinical evidence from 2024 and 2025. This approach demonstrates high safety, effective local tumor control, and improved patient quality of life. Compared to traditional therapies, it offers fewer adverse effects, preserves critical structures, and holds potential for synergy with immunotherapy for long-term benefits. Recent studies, including systematic reviews of ECT for pancreatic ductal adenocarcinoma and IRE reports in gastrointestinal cancers, underscore the bright future of this technology, which could redefine treatment standards. Further research is needed to standardize protocols and assess long-term outcomes. For Iranian patients, Pars Tarava provides a unique opportunity to access this state-of-the-art technology. If you or a loved one are facing this challenge, we encourage reaching out to Pars Tarava’s specialists to explore the best treatment options available.
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Sources:
https://pmc.ncbi.nlm.nih.gov/articles/PMC5538044/
https://www.mdpi.com/2072-6694/17/3/408
https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2024.1353800/full
https://journals.lww.com/otm/fulltext/9900/irreversible_electroporation__current_research.75.aspx
https://pmc.ncbi.nlm.nih.gov/articles/PMC11840168/
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