Quick answer
Metastatic epidural disease, a tumour extension into the epidural space that can compress the spinal cord, can be treated by CT-guided electrochemotherapy. This technique combines bleomycin and electrical pulses, and is decided at the oncology multidisciplinary tumour board.
📖 What is neoplastic epidural involvement?
Epidural electrochemotherapy (epidural ECT) is an innovative technique for treating neoplastic epidural disease (spinal cord compression by epidural metastasis) by local administration of chemotherapy coupled with electroporation in the epidural space. It aims to reduce the tumour mass compressing the spinal cord, in order to preserve or restore neurological function.
This technique is offered at Cochin Hospital AP-HP in the setting of non-surgical metastatic spinal cord compression. It is an alternative or a complement to stereotactic spinal radiotherapy and decompression surgery.
⚡ Electrochemotherapy for epidural disease at a glance: key figures
For certain inoperable tumoural epidural lesions, electrochemotherapy combines local chemotherapy with electrical pulses, for local control of the disease and of the pain.
| Criterion | Data |
|---|---|
| Indication | Symptomatic tumoural epidural disease, not amenable to surgery |
| Anaesthesia | General or local depending on the extent of the lesion |
| Objective | Local control of pain and compression, decided at a multidisciplinary meeting |
| Cost | Covered by French national health insurance at Cochin AP-HP, no out-of-pocket fees |
Data validated by the team of Prof. Anthony Dohan, Department of Interventional Radiology, Cochin Hospital AP-HP, Université Paris Cité.
🎯 Principle
Electrochemotherapy (ECT) is a technique combining the application of short, intense electrical pulses (electroporation) with the local or systemic injection of a chemotherapy agent (bleomycin or cisplatin). The electrical pulses transiently permeabilise the tumour cell membrane, massively increasing intracellular uptake of the cytotoxic agent and its efficacy.
In metastatic epidural disease (invasion of the epidural space by vertebral metastases), image-guided percutaneous ECT allows local treatment of the compressive lesions, as a complement or alternative to conventional treatments.
📋 Indications
- Vertebral metastases with symptomatic epidural invasion
- Refractory spinal pain of metastatic origin
- Local recurrence after radiotherapy (when re-irradiation is not possible)
- Tumours refractory to systemic chemotherapy
- Complementary treatment after vertebroplasty or cementoplasty
The decision is made at the oncology multidisciplinary tumour board, in conjunction with medical oncology, radiotherapy and neurosurgery.
🔧 Course of the procedure
Preoperative work-up: recent spinal MRI, blood tests, oncological assessment. General anaesthesia required.
CT guidance: percutaneous placement of the electrodes around the epidural lesion, with real-time control of their position.
Injection of the cytotoxic agent (intravenous or local bleomycin) then application of the electrical pulses according to the ESOPE protocol (sequences of 8 pulses of 100 µs).
Hospital stay: 1 to 2 nights in neurosurgery or medicine. Neurological monitoring.
Evaluation at 6-8 weeks: follow-up MRI, assessment of pain (VAS) and mobility.
📊 Expected results
- Pain reduction in 70 to 80% of cases
- Local control of the epidural lesion in 60 to 70% of cases at 3 months
- Preservation or improvement of neurological function in the majority of cases treated early
✅ What are the expected benefits?
- Pain reduction in 70 to 80% of cases
- Local control of the epidural lesion in 60 to 70% of cases at 3 months
- Preservation or improvement of neurological function in the majority of cases treated early
- Alternative for patients with recurrence after radiotherapy (when re-irradiation is not possible)
- Can be combined with vertebroplasty/cementoplasty to consolidate the vertebra
🩹 What are the possible complications?
| Complication | Description | Frequency |
|---|---|---|
| Transient neurological worsening | Related to post-procedure oedema; close neurological monitoring | < 5% |
| Haematoma at the puncture site | Resolves spontaneously | 2-5% |
| Insufficient response | Other treatments may be discussed | 30-40% |
📐 What are the limits of the treatment?
Local control is achieved in only 60 to 70% of cases at 3 months, and neurological improvement depends strongly on how early treatment is started: spinal cord compression that has been present for several days responds less well. In all cases, decompression surgery or radiotherapy remain possible.
🔀 What other techniques and alternatives are possible?
☢️ Stereotactic radiotherapy
Reference treatment of metastatic spinal cord compression, first-line if re-irradiation is possible.
🏥 Decompression surgery
Emergency laminectomy or surgical stabilisation for severe compressions with progressive neurological deficit.
💊 Corticosteroids / systemic treatment
High-dose corticosteroids as an emergency to reduce peritumoural oedema, systemic treatments depending on the tumour type.
❔ What happens if I finally decline the treatment?
You remain entirely free in your decision. Your case will be discussed at the multidisciplinary tumour board to consider the alternatives: radiotherapy, decompression surgery, or corticosteroids depending on your situation. Without treatment, progressive spinal cord compression can lead to gradual neurological worsening.
📄 Patient leaflet to download
Patient information leaflet
To read before your consultation (French version).
❓ Frequently asked questions
What is neoplastic epidural involvement?
Is epidural ECT available as an emergency?
Is a referral letter necessary?
✅ Procedure covered by French national health insurance (Assurance Maladie) · No extra fees · Cochin Hospital AP-HP
📚 Scientific references
Probst U, Fuhrmann I, Beyer L, Wiggermann P. Technol Cancer Res Treat 2018;17:1533033818785329.
🔗 Related pages
✓ Why this page is trustworthy
Written by the Interventional Radiology team at Cochin Hospital AP-HP, Université Paris Cité. Medically reviewed by an interventional radiologist of the department. Last updated: July 2026.