successful Treatment of a jaw tumor with the Pars Tarava electrochemotherapy device

Treatment of a jaw tumor with the Pars Tarava electrochemotherapy device — a successful case report and comprehensive review

In recent years, electrochemotherapy (ECT) has emerged as an innovative approach for treating malignant tumors. This method combines low-dose chemotherapy with the application of short, high-intensity electric fields, aiming to increase the penetration of chemotherapeutic agents into tumor cells. Treating a jaw tumour with electrochemotherapy can be a minimally invasive option for patients who are not candidates for surgery or radiotherapy, or for whom those interventions carry a high risk, particularly elderly patients. In this article, we present a thorough introduction to the mechanism of ECT, the pharmacology of bleomycin, the scientific evidence for treating head and neck tumors (especially the jaw), and a case report of an 83-year-old patient with a lower-jaw tumor treated using the Pars Tarava electrochemotherapy device.

Understanding electrochemotherapy and electroporation

Treatment Process of electrochemotherapy

Electrochemotherapy (ECT) is a technique in which low-dose chemotherapeutic drugs — typically bleomycin or cisplatin — are used in conjunction with the application of short, high-intensity electrical pulses to the tumor. The electrical pulses increase cell membrane permeability (the phenomenon of electroporation), allowing hydrophobic and bulky molecules like bleomycin to enter cells more easily. As a result, even very low drug doses can exert substantial cytotoxic effects on cancer cells; it is estimated that ECT increases the effectiveness of bleomycin by 300 to 700 times.

Electroporation exists in two forms: reversible and irreversible. In electrochemotherapy, pulses are configured to transiently increase membrane permeability for a few minutes without causing permanent structural damage to the membrane, thereby permitting greater drug uptake into the cell. Besides enhancing drug entry, this phenomenon induces a temporary vascular lock in the tumor and increases drug retention within the tumor tissue. It also stimulates an immune response against tumor cells, which can help eliminate residual tumor remnants.

Application of electrochemotherapy in head and neck tumors

Head and neck tumors — including skin cancers, oral mucosal tumors, salivary gland cancers, and jaw tumors — can be challenging to treat surgically or with radiotherapy due to the complex anatomy of the region and the proximity of vital structures. Electrochemotherapy, as a local and minimally invasive method, has proven effective in controlling such tumors. In a clinical study of 33 patients with cutaneous head and neck cancers, 82% achieved a complete response and 18% a partial response after ECT; seven months later, 96% of patients had wound sites resembling normal skin, and oral and ocular functions were preserved. These results indicate that ECT not only controls tumors but also yields favorable cosmetic and functional outcomes.

Other studies show that tumor response to ECT depends on tumor size; according to NICE guidelines, the complete response rate was 66% for tumors smaller than 1.5 cm, 36% for tumors 1.6–3 cm, and 28% for tumors larger than 3 cm. In another study on patients with cutaneous metastases, an objective response rate of 85% and a complete response rate of 74% were reported. These findings highlight the importance of patient selection and tumor size in determining ECT success. For deep-seated head and neck tumors — particularly jaw tumors and deep lymph node metastases — the use of needle electrodes and treatment planning is critically important.

Clinical evidence and study results

Response rates and the impact of tumor size

A review of multiple studies indicates that tumor size is a key determinant of response to electrochemotherapy. In an analysis of 446 patients with cutaneous metastases, the complete response rate for tumors smaller than 1.5 cm was 66%, for tumors 1.6–3 cm it was 36%, and for tumors larger than 3 cm it was only 28%. This suggests that ECT is highly effective for small-to-medium tumors and can be used for debulking larger tumors.

Response in head and neck tumors

In the DAHANCA 32 study on mucosal head and neck tumors, bleomycin was administered at 15,000 IU/m² intravenously, yielding an overall response rate (complete + partial) of 58%; in 16 of 17 biopsies taken four weeks after treatment, no cancer cells were found. The EURECA project (2017) in Europe reported a 56% overall response rate (18% complete), with tumors under 3 cm showing better responses. Another study by Piki and colleagues on 36 patients reported a 100% overall response (mostly partial responses).

Functional and cosmetic benefits

One of the significant advantages of electrochemotherapy is the preservation of function and appearance. In head and neck cancers, radical surgery can lead to complications that affect speech, swallowing, and facial appearance. An Acta Dermato-Venereologica report indicated that among 33 patients with cutaneous head and neck cancers, 96% of wounds resembled normal skin and oral and ocular functions were preserved. ECT is particularly valuable for patients who are elderly or medically unfit for surgery or radiotherapy.

Quality-of-life improvement

Alongside tumor control, ECT plays a significant role in improving patients’ quality of life. NICE guidelines reported that 94% of patients experienced improvements after ECT in bleeding, wound condition, appearance, daily activities, social relationships, or pain control. This suggests that ECT not only treats cancer but also reduces distressing symptoms and enhances psychosocial functioning.

Case report: Treatment of a lower-jaw tumor in an 83-year-old patient

Treatment of a jaw tumor with the Pars Tarava electrochemotherapy device

Patient characteristics

An 83-year-old female patient presented with a malignant tumor of the lower jaw. The tumor measured approximately 3 × 2.7 cm on initial examination and caused pain, difficulty chewing, and cosmetic concern. Due to advanced age, comorbidities, and the high risk associated with extensive surgery, the decision was made to treat the jaw tumor with electrochemotherapy. After consultation and review of the medical record, the patient was deemed a suitable candidate for ECT.

Planning and preparation

Imaging review and planning: CT/MRI imaging was performed to determine the exact tumor location and adjacent structures (major vessels, the inferior alveolar nerve, and the jawbone). Treatment planning was conducted by the hospital medical team in collaboration with Pars Tarava to ensure complete coverage of the tumor by the electric field.
Electrode selection: Given the tumor’s depth and size, appropriately sized needle electrodes were chosen to ensure a homogeneous electric field covering the entire tumor volume.
Drug administration: According to the ESOPE protocol, bleomycin was administered intravenously at a dose of 15,000 IU/m². The patient was instructed to avoid anticoagulants and medications that affect cardiac function prior to the procedure.

Treatment steps

Anesthesia and electrode placement: The patient underwent general anesthesia to prevent muscle contractions caused by electrical pulses. Under image guidance, electrodes were inserted into planned positions within the mandibular tissue; electrode spacing was adjusted so that the entire tumor and a safety margin were encompassed.
Pulse delivery: A series of 100-microsecond pulses at appropriate voltages were delivered by the Pars Tarava electrochemotherapy device. Pulses were completed within 3–5 minutes, with synchronization to the absolute refractory period of the cardiac cycle to avoid cardiac complications.
Number of sessions: Based on the initial tumor size, three ECT sessions were planned at four-week intervals. Tumor size was evaluated after each session.

Treatment results

After the first session, the tumor size decreased noticeably and the patient’s pain and chewing difficulties improved. As visible in the images, by the end of the third session, a 96% reduction in tumour dimensions was observed, and the lesion’s size had decreased to approximately 0.12 cm². This dramatic reduction eliminated the need for extensive surgery, leaving only minor debridement of necrotic tissue.

Pathological examination of tissue samples after treatment revealed complete necrosis and absence of malignant cells. The patient experienced only mild side effects such as transient oral mucosal inflammation and short-term muscle contractions, which resolved within a few days. No systemic complications or nerve damage were observed.

Discussion and significance of the case

This report demonstrates that treating a jaw tumor with electrochemotherapy is a highly effective option for patients unable to tolerate surgery or radiotherapy. The significant tumor reduction achieved over three sessions and the avoidance of systemic chemotherapy side effects underscore the value of this approach. Precise treatment planning and the use of needle electrodes in this case ensured uniform coverage of the tumor by the electric field while preserving surrounding healthy tissue. This method also allows repeat treatments and, in cases of residual tumor or local recurrence, additional sessions can be administered.

Advantages of electrochemotherapy compared to conventional treatments

Preservation of function and appearance: Unlike surgery that may require resection of part of the jaw, tongue, or adjacent tissues, ECT preserves vital structures and provides favorable cosmetic outcomes.
Fewer systemic side effects: Because of the low drug dose used, systemic toxicities such as bone marrow suppression, severe nausea, or hair loss are uncommon.
Suitability for elderly or comorbid patients: ECT is safer and better tolerated than major surgery in older patients and can often be performed on an outpatient basis.
Repeatability and combination with other therapies: ECT can be repeated multiple times or used as an adjunct prior to surgery or radiotherapy to reduce tumor volume.
Immune stimulation: In addition to enhancing drug uptake, electrical pulses boost the immune response against tumor cells; this may help the immune system clear residual malignant cells after physical tumor destruction.

Possible complications and post-treatment care

Although ECT is safer than many conventional treatments, it can have side effects:

Pain and muscle contractions: Short-term, during pulse delivery, controllable with anesthesia.
Inflammation or redness of skin and mucosa: May persist for several days; antiseptic mouthwash and avoidance of irritating foods are recommended.
Superficial ulceration or necrosis: Especially in areas exposed to high electric field intensity; typically heals within weeks.
Transient sensory disturbance: Some patients experience temporary numbness or paresthesia due to the passage of current near sensory nerves in the jaw; this is usually transient.

Post-treatment care includes pain management, antibiotics if necessary, maintaining good oral hygiene, and periodic follow-up to assess the treatment response. Patients are advised to avoid smoking and alcohol and to follow a soft, nutritious diet to reduce the risk of complications.

Conclusion

Electrochemotherapy, as a minimally invasive method grounded in advanced science, has brought a significant transformation to the treatment of head and neck tumors. By combining electrical pulses with bleomycin, ECT increases drug penetration into tumor cells and induces selective cancer cell death. In the case presented, an 83-year-old patient with a lower-jaw tumor achieved a 96% reduction in tumor size after three ECT sessions and avoided extensive surgery. Clinical evidence indicates that ECT, in addition to high efficacy, helps preserve function and appearance, reduces systemic side effects, and improves quality of life. Given aging populations and the need for lower-risk options, treating jaw tumors with electrochemotherapy may be an ideal choice for elderly patients or those for whom surgery is not feasible.

Introduction to Pars Tarava

Pars Tarava is the first and only manufacturer of electroporation and electrochemotherapy devices in Iran. Leveraging up-to-date technical knowledge and collaboration with domestic specialists, the company has designed and produced advanced devices for performing ECT across various tumor types. Pars Tarava’s products enable precise treatment planning, delivery of controlled pulses, and safe use in clinical settings. The company also provides training, technical support, and specialized consultation services for healthcare centers.