Electric Pulses and Cisplatin Erase Traces of Deadly Childhood Tumor in Landmark First

In a development that could reshape how doctors confront one of childhood’s most stubborn cancers, clinicians in Rome have reported the first-ever use of a technique called electrochemotherapy in a child with high-risk neuroblastoma. The procedure, described in a case report published in the journal CVIR Oncology, was performed on a seven-year-old girl whose abdominal tumor had survived an arsenal of conventional therapies, including multiple chemotherapy regimens, antibody treatment, radioactive iodine therapy, and stem-cell transplantation. What makes the outcome remarkable is not merely that the child tolerated the intervention without complications, but that a year later, the metabolically active core of her tumor—the part that imaging had continued to flag as dangerous—showed no trace of activity at all. For a disease in which residual active tumor is one of the strongest predictors of relapse and death, that single data point carries enormous weight.

Neuroblastoma is a cancer of the sympathetic nervous system that arises most often in the adrenal glands or along the spine, and it accounts for a disproportionate share of childhood cancer deaths. The girl at the center of this report carried one of the worst prognostic markers in the disease: amplification of the MYCN gene, a genetic signature associated with aggressive, treatment-resistant tumors. Her initial treatment followed the standard European induction protocol known as COJEC, a rapid cycle of cisplatin, vincristine, carboplatin, etoposide, and cyclophosphamide, followed by two courses of topotecan, vincristine, and doxorubicin. When doctors re-evaluated her disease, the news was grim. The primary tumor in her abdomen remained large and active, it pressed on critical blood vessels, and scans revealed widespread involvement of her bones and bone marrow, yielding a skeletal disease score of 45 on the SIOPEN scale used across European pediatric oncology centers.

What followed was a relentless escalation of therapy. Second-line chemotherapy with temozolomide and irinotecan, later combined with the anti-GD2 antibody dinutuximab beta, succeeded in clearing the metastatic disease from her bones and marrow. She then underwent consolidation with two rounds of radiometabolic therapy using iodine-131 labeled MIBG—a radioactive form of the same tracer molecule used to image neuroblastoma—each followed by reinfusion of her own stem cells, and finally high-dose chemotherapy with busulfan and melphalan supported by another stem-cell rescue. Yet when the dust settled, one enemy remained entrenched: a residual mass in her retroperitoneum, the space behind the abdominal organs, measuring 13.3 by 9.8 by 6.9 centimeters. The mass continued to light up on MIBG scans, proof that living neuroblastoma cells persisted within it, and it wrapped around the celiac artery and the right renal artery while compressing the inferior vena cava, the largest vein in the body.

This anatomical situation presented surgeons with an impossible calculus. Any attempt at resection risked catastrophic hemorrhage from vessels that the tumor had encased, and there was no guarantee that a complete removal could be achieved even at that price. A biopsy taken through the skin confirmed that the mass contained viable neuroblastoma tissue showing differentiating features, meaning the cells were still alive and capable of regrowth. It was at this impasse that a multidisciplinary tumor board—bringing together pediatric oncologists, surgeons, interventional radiologists, pathologists, and radiation therapists at Bambino Gesù Children’s Hospital in Rome—turned to a technique that had never before been applied to a child with this disease: percutaneous electrochemotherapy.

The principle behind electrochemotherapy is elegantly physical. Cell membranes, though thin, are formidable barriers that normally prevent many chemotherapy drugs from entering cells efficiently. When short, high-voltage electric pulses are applied across a tissue, they transiently reorganize the lipid bilayer of those membranes, opening nanoscale pores in a process called reversible electroporation. The pores allow drug molecules to flood into the cell interior, and because the pulses are calibrated carefully, the membranes reseal afterward and the cells survive—only to be killed by the chemotherapy they have now absorbed in quantities far beyond what ordinary exposure could achieve. The drugs most commonly paired with electroporation are bleomycin and cisplatin, both of which become dramatically more cytotoxic inside electroporated cells. In adults, the technique has earned validated roles against melanoma, sarcoma, and head and neck tumors, but pediatric experience has been almost nonexistent.

The Roman team tailored the procedure to the unique biology of neuroblastoma. Rather than administering cisplatin intravenously, they injected it directly into the tumor, a strategy designed to maximize drug concentration within the lesion while minimizing systemic side effects—a rational choice given that platinum compounds are among the drugs to which neuroblastoma is classically sensitive. Under general anesthesia, with the child positioned prone, three variable-geometry needle electrodes with an active length of three centimeters were inserted intercostally, between the ribs, using computed tomography and ultrasound guidance. The target was the most metabolically active portion of the mass, precisely the region where MIBG single-photon emission imaging had shown the greatest tracer uptake and where the tumor pressed hardest against the inferior vena cava. Once the electrodes bracketed the target, an 18-gauge coaxial biopsy was taken through the field, and four milligrams of cisplatin at a concentration of two milligrams per milliliter were injected through a Chiba needle. The Cliniporator VITAE device then delivered voltage pulses ranging from 900 to 1,700 volts, completing the session.

The technical choreography matters because electroporation is unforgiving of sloppy planning. The electric field must cover the entire tumor volume homogeneously; any region that falls between electrodes may receive sub-lethal exposure and survive as a seed of recurrence. This is why careful pre-treatment planning and meticulous electrode placement are considered the linchpins of the technique, particularly for large or irregularly shaped lesions like the one in this case. Encouragingly, the procedure itself was uneventful. No immediate or delayed complications occurred, post-procedure monitoring revealed nothing concerning, and the child was discharged in stable condition. The team notes that the approach is also repeatable, an important attribute for a disease where residual lesions sometimes require more than one local intervention.

The follow-up imaging tells the story in two snapshots. One month after the procedure, magnetic resonance imaging revealed a necrotic, liquefied area of 20 by 20 millimeters within the treated field—direct evidence that the electroporated cells had died on schedule, consistent with the six-to-eight-week window in which electrochemotherapy’s radiological effects typically become apparent. The child then completed her maintenance phase of treatment with cis-retinoic acid and dinutuximab beta without any complications. Twelve months after the procedure, computed tomography and MIBG imaging delivered the decisive verdict: the mass had shrunk to 9.2 by 8.9 by 9.4 centimeters, and, critically, no residual MIBG uptake could be detected anywhere in the treated area. The metabolically active component that had survived everything modern pediatric oncology could throw at it had been silenced.

Why does the disappearance of MIBG avidity matter so much? MIBG is a norepinephrine analog that is taken up specifically by neuroblastoma cells, so persistent tracer uptake is a molecular signature of living tumor. In neuroblastoma, residual primary disease that remains MIBG-avid after multimodal treatment is a well-established negative prognostic factor, strongly correlated with relapse and poor survival. The ability to selectively target and neutralize these metabolically active foci—without opening the abdomen, without thermal energy that could damage vessels and adjacent organs, and without adding systemic toxicity—addresses one of the most frustrating gaps in current therapy. Thermal ablation techniques such as radiofrequency ablation and cryoablation have been used in selected pediatric tumors, but they are hazardous near major vessels, which act as heat sinks and limit ablation margins, and near structures like the celiac artery that cannot tolerate thermal injury. Electrochemotherapy’s non-thermal mechanism sidesteps that constraint, and the authors note that its effects are applicable across tumor histologies, including tumors resistant to other modalities.

The caveats are as important as the promise. This is a single case, reported by the team of Giulia Cassanelli, Maria Antonietta De Ioris, and Gian Luigi Natali, and pediatric oncology is littered with promising one-patient results that failed to generalize. The authors themselves are careful, framing electrochemotherapy as a feasible local option for selected patients and calling for further evaluation within a multidisciplinary framework rather than declaring a new standard of care. Yet the signals here are hard to dismiss: a first-in-child application performed safely in one of the most anatomically hostile locations imaginable, durable local control of the exact tumor component that predicts relapse, and a treatment that can be repeated if needed. If larger studies confirm these findings, children with refractory neuroblastoma whose tumors are deemed inoperable may one day have an option that today they lack entirely—a minimally invasive, precisely targeted way to finish what chemotherapy, antibodies, and radiation started.

Subject of Research: Electrochemotherapy for residual MIBG-avid disease in refractory pediatric neuroblastoma

Article Title: Electrochemotherapy as a potential local treatment for residual MIBG-avid disease in refractory pediatric neuroblastoma: a case report

Article References: Cassanelli, G., De Ioris, M. A., & Natali, G. L. (2026). Electrochemotherapy as a potential local treatment for residual MIBG-avid disease in refractory pediatric neuroblastoma: a case report. CVIR Oncology, 2(1), Article 3. https://doi.org/10.1007/s44343-026-00032-8

Image Credits: AI Generated

DOI: 10.1007/s44343-026-00032-8

Keywords: neuroblastoma, electrochemotherapy, electroporation, cisplatin, pediatric oncology, interventional radiology, MIBG imaging, tumor ablation, MYCN amplification, residual disease, case report, local therapy