Electrochemotherapy (ECT) combines standard chemotherapy drugs with precisely controlled electrical pulses to dramatically enhance drug entry into cancer cells — achieving tumour kill rates impossible with chemotherapy or radiotherapy alone. Pioneered in Asia by Dr. Vinod T. Gore at Sahyadri Manipal Hospital, Deccan, Pune in 2013.
Two historic milestones that placed India — and Pune — on the global map of advanced cancer surgery. A story of vision, determination, and the commitment to bringing world-class cancer treatment to Indian patients.
Dr. Vinod T. Gore first encountered Electrochemotherapy through European clinical literature and ESOPE (European Standard Operating Procedures) guidelines. Recognising its potential for Indian patients — particularly those with unresectable cutaneous tumours — he pursued training and planning to introduce ECT to India.
The Vision BeginsDr. Vinod T. Gore performed the first Electrochemotherapy procedure in Asia at Sahyadri Hospital, Deccan, Pune in 2013. This landmark procedure opened a new chapter in cancer treatment for the continent — bringing a technique previously available only in Europe to Asian patients for the first time. The results were presented at national oncology conferences.
First in Asia — HistoricRecognising that imported European ECT equipment (from manufacturers like IGEA, Italy) was prohibitively expensive for most Indian hospitals, Dr. Gore played a key role in collaborating with Indian engineers and manufacturers to develop and validate the first indigenous ECT machine made in India. This dramatically reduced costs, making ECT accessible to far more patients across India.
Make in India · Accessible CareElectrochemotherapy is a locally applied, minimally invasive cancer treatment that combines the power of standard chemotherapy drugs with controlled electrical pulses. The electrical pulses cause a phenomenon called electroporation — temporary formation of pores in the cancer cell membrane — which allows chemotherapy to enter cancer cells at concentrations thousands of times higher than would normally penetrate.
The technique is elegantly simple in concept: first, a small dose of chemotherapy is administered (either intravenously or injected directly into the tumour). Then, a pair of needle or plate electrodes are placed around the tumour and deliver precisely calibrated electrical pulses — typically 8 pulses of 100 microseconds duration at ~1,000 volts per centimetre — for just a few minutes.
The result is rapid, localised, highly effective tumour destruction — with minimal systemic side effects, because the chemotherapy dose used is far lower than standard systemic chemotherapy. The same drug that would have minimal effect at normal tissue concentrations becomes devastatingly effective once electroporation forces it inside cancer cells.
When I first read about Electrochemotherapy, I knew this was something Indian cancer patients needed. Many patients I saw had unresectable, bleeding, fungating tumours — too far gone for surgery, resistant to radiation, causing enormous suffering. ECT offered them a real option.
Performing the first ECT in Asia at Sahyadri Hospital Deccan in 2013 was a deeply satisfying moment. And then helping to build an Indian-made ECT machine — bringing the cost within reach of more hospitals — that felt like completing the mission. My goal has always been to bring the best cancer technology to patients in Pune and across India.
Today ECT is an established part of my practice. I have treated patients with melanoma, breast chest wall recurrence, head & neck tumours, and unresectable skin metastases — with remarkable results in many cases.
— Dr. Vinod T. Gore, MBBS MS FAIS FIAGES FARIS (Edin)ECT combines a pharmacological effect (chemotherapy) with a physical effect (electroporation) — the two acting in synergy to destroy cancer cells with unprecedented local efficiency.
Bleomycin is given intravenously (or Cisplatin injected intratumorally). The drug reaches the tumour but cannot enter cells efficiently through intact membranes.
An 8-minute wait allows IV Bleomycin to distribute through the bloodstream and reach peak concentration in the tumour vasculature.
Electrodes placed around the tumour deliver 8 high-voltage pulses (100μs each, ~1000 V/cm). This causes reversible electroporation — temporary pores form in cancer cell membranes.
Through the open pores, Bleomycin floods into cancer cells at 3000× the normal intracellular concentration — causing irreparable DNA damage and tumour cell death (apoptosis & necrosis).
Bleomycin is a naturally hydrophilic molecule — it cannot cross cell membranes efficiently under normal circumstances. Only about 0.1% of extracellular Bleomycin enters a cell without electroporation. With ECT, that figure rises to 100% — every molecule present in the tumour gets forced inside every cancer cell.
This localised drug concentration is cytotoxic to all cell types regardless of histology — ECT works equally well on melanoma, carcinoma, sarcoma, or any other tumour type. The electroporation effect does not discriminate by cell type — which is why ECT is the only cancer treatment that works universally across all tumour types.
The electrical pulses last just 100 microseconds each — a fraction of a millisecond. The total electrical pulse time for a complete ECT session is under 1 millisecond. The effects are entirely localised to the electrode field — surrounding normal tissue is unaffected because drug concentrations there are far lower.
ECT is most effective for cutaneous and subcutaneous tumour deposits — accessible to electrode placement. It is histology-agnostic: any cancer type accessible to the electrodes can be treated.
The most established indication. ECT is highly effective for cutaneous and subcutaneous melanoma deposits — both primary and metastatic. Multiple nodules can be treated in a single session. Particularly valuable when surgical resection would cause unacceptable morbidity or is not feasible.
85–90% Objective Response RateLocoregional chest wall recurrence after mastectomy — often unresectable, causing bleeding, ulceration, and pain. ECT controls disease locally, reduces bleeding, and significantly improves quality of life in patients with previously untreatable chest wall disease.
High Local Control RateUnresectable or recurrent head and neck cancers — including oral cavity, skin, and neck nodal metastases — where surgery or re-irradiation is not possible. ECT can debulk tumour, control bleeding, and relieve obstruction, restoring significant quality of life.
Good Local ResponseAny fungating, ulcerating, or actively bleeding tumour deposit — regardless of cancer type — can be treated with ECT to achieve haemostasis and tumour debulking. Particularly valuable in palliative settings where bleeding is causing distress and is not controlled by radiotherapy.
Excellent HaemostasisOne of the original indications for ECT in European clinical trials. Both cutaneous and mucosal Kaposi's sarcoma lesions respond very well to ECT — with high complete response rates. Particularly relevant in immunocompromised patients where systemic treatment is poorly tolerated.
Very High Response RateMerkel cell carcinoma, basal cell carcinoma, squamous cell carcinoma, cutaneous lymphoma, and subcutaneous metastases from any primary cancer — particularly where surgery or radiotherapy is not feasible or has been exhausted. ECT works across all histologies.
Histology-AgnosticECT is typically a day-care procedure performed under general anaesthesia or deep sedation. A single session treats all accessible tumour deposits simultaneously.
Tumour deposits are mapped clinically and on imaging (CT / PET-CT / MRI). Number, location, and depth of lesions determine electrode type (needle vs plate electrodes) and access strategy. Allergy screening for Bleomycin is performed. Pulmonary function tests are done as Bleomycin can rarely cause pulmonary toxicity at high cumulative doses.
ESOPE Protocol — European Standard FollowedUnder GA or sedation: Bleomycin 15,000 IU/m² is given IV (or Cisplatin injected intratumorally). After 8 minutes, electrodes are systematically placed around each tumour deposit and 8 square-wave electric pulses (100µs, 1000 V/cm, 1 Hz frequency) are delivered per placement. All lesions are treated sequentially. Muscle contractions occur during pulses — this is expected and is managed under anaesthesia.
30–60 Minutes Total — Day Care ProcedurePatients typically go home the same day or stay one night. Treated areas develop local swelling and erythema over 48–72 hours — followed by progressive tumour necrosis and eschar formation over 2–4 weeks. Response is assessed clinically and with imaging at 4–8 weeks. Repeat sessions can be performed if residual viable tumour remains or new deposits develop. Most patients require only 1–2 sessions.
Response Assessment at 4–8 Weeks Post-ECTOnly two drugs are used in ECT globally — Bleomycin and Cisplatin. Bleomycin is the preferred and most extensively studied agent, with a 3,000-fold enhancement with electroporation.
| Drug | Route | Dose | Enhancement | Best For | Advantage |
|---|---|---|---|---|---|
| Bleomycin 3000× Enhanced | Intravenous (IV) | 15,000 IU/m² — given 8 minutes before pulse delivery | 3,000-fold increase in intracellular concentration with electroporation | MelanomaBreast CWRHead & NeckAll histologies | Systemic distribution reaches all tumour deposits simultaneously — ideal for multiple lesions |
| Bleomycin 3000× Enhanced | Intratumoural (IT) injection | 1,000 IU/cm³ of tumour volume — injected directly into each lesion | 3,000-fold increase — higher local concentration than IV route | Single large lesionsDeep deposits | Higher local drug concentration; avoids systemic distribution; useful when IV not feasible |
| Cisplatin ~80× Enhanced | Intratumoural (IT) injection | 0.5–1 mg/cm³ of tumour volume — injected into each lesion separately | ~80-fold increase in intracellular concentration with electroporation | Squamous Cell Ca.Bleomycin contraindicated | Preferred when Bleomycin is contraindicated (prior high cumulative dose; impaired pulmonary function) |
When Dr. Gore pioneered ECT in Asia in 2013, the only available equipment was manufactured in Europe — primarily by IGEA S.r.l., Italy (the Cliniporator™ system). These machines were expensive to import, had high maintenance costs, and were subject to foreign exchange fluctuations — making ECT inaccessible to most Indian hospitals and patients.
Dr. Gore recognised that for ECT to fulfil its promise across India, an affordable, locally manufactured, clinically validated ECT machine was essential. He collaborated with Indian biomedical engineers and manufacturers to contribute his clinical expertise — translating the ESOPE protocol technical requirements into an indigenously designed pulse generator system capable of delivering equivalent therapeutic electrical parameters.
The result: India's first indigenous Electrochemotherapy machine — manufactured in India, validated against international standards, and capable of delivering the same therapeutic 8-pulse electroporation protocol as imported equipment. At a fraction of the import cost, this breakthrough made ECT financially viable for Indian cancer hospitals and patients.
Entirely designed, manufactured, and validated in India — reducing dependence on expensive imported European biomedical equipment.
Cost of the indigenous machine is a fraction of European equivalents — making ECT financially accessible to more hospitals and more patients across India.
Validated against the ESOPE international protocol — delivering equivalent therapeutic pulse parameters to international standard equipment.
ECT has a robust clinical evidence base from European multicentre trials (ESOPE, EORTC) and growing Asian data following Dr. Gore's pioneering work. Response rates are consistently high across tumour types.
ECT offers a combination of features not available in any other cancer treatment — making it uniquely valuable for specific clinical situations.
Works across all tumour types — electroporation enhances drug entry regardless of cancer cell histology. No biomarker testing needed.
ECT can be repeated multiple times — unlike radiotherapy, which has lifetime dose limits. New deposits can be treated as they appear.
A single 30–60 minute session under sedation or GA — most patients go home the same day. No prolonged hospitalisation required.
The Bleomycin dose used is far lower than standard chemotherapy. Systemic side effects are minimal — suitable for patients who cannot tolerate full-dose chemotherapy.
ECT causes immediate vascular shutdown in treated tumours — making it uniquely effective for controlling haemorrhage from bleeding cancer deposits.
Effective even in tumours resistant to radiotherapy and systemic chemotherapy — the electroporation mechanism is independent of drug resistance pathways.
ECT can be combined with immunotherapy (possible abscopal effect), surgery, or systemic chemotherapy — without significant interaction or additive toxicity.
With India's first indigenous ECT machine (developed with Dr. Gore's contribution), ECT is now available at significantly lower cost than imported equipment-based treatment.
ECT has an excellent safety profile. Side effects are predominantly local — affecting only the treated area. Systemic effects are minimal due to the low chemotherapy dose used.
Involuntary muscle contractions during electrical pulse delivery are expected — managed completely under general anaesthesia or deep sedation. Patients are unaware of this during the procedure.
Redness and swelling around treated tumour deposits — appears within 24–48 hours and resolves over 1–2 weeks. Part of the normal inflammatory response to tumour cell death.
Treated tumour deposits undergo necrosis over 2–4 weeks — forming a dry eschar (scab). This is the expected and desired response — the dead tumour tissue gradually separates and heals.
Mild to moderate pain at electrode insertion sites — managed with standard analgesics. Usually settles within a few days. Deeper treatments may require more analgesia post-procedure.
Bleomycin can rarely cause pulmonary fibrosis at high cumulative doses (>400,000 IU lifetime). The low dose used in ECT makes this very unlikely — but pulmonary function is assessed before treatment in patients with prior Bleomycin exposure.
Darkening of the skin over treated areas — a common, harmless local effect. Usually fades gradually over weeks to months after treatment. Not a sign of recurrence.
ECT has one of the best safety profiles of any cancer treatment. The low Bleomycin dose used, localised effect of electrical pulses, and day-care nature of the procedure make it well tolerated even in patients with poor performance status or multiple comorbidities — for whom surgery or full-dose chemotherapy may not be feasible.
If you have an unresectable, bleeding, or cutaneous tumour deposit that has not responded to standard treatment — ECT may offer excellent local control. Book a consultation with Dr. Gore, the first surgeon to perform ECT in Asia.