Electrochemotherapy in pediatrics: a systematic review

OBJECTIVES: To systematically review the available evidence on electrochemotherapy (ECT) in pediatric patients, focusing on indications, treatment parameters, efficacy, and safety. MATERIALS AND METHODS: A systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD42024575588). MEDLINE, Embase, and Cochrane Library databases were searched. Studies reporting the use of ECT in patients ≤ 18 years were included. Data extraction covered patient demographics, pathologies, electroporation parameters, agents used, and outcomes. Risk of bias was assessed using ROBINS-I. RESULTS: Out of 1579 screened studies, 15 met the inclusion criteria, reporting at least 127 pediatric patients. Age was provided for 98 patients (pooled mean 8.5 years, range 0-17) and sex for 108 (58 female, 50 male). Two studies described tumors; the remainder reported vascular anomalies (VAs). Reversible electroporation with intralesional or intravenous bleomycin was the most common protocol. Complete response rates for tumors were 97-100%. Pooled volume reductions in VAs ranged from 52% to 100%. Most complications were minor, though serious events occurred, including sciatic nerve injury, disseminated intravascular coagulation, and airway compromise. Methodological quality was low, with small sample sizes and inconsistent reporting of multiple parameters. CONCLUSION: ECT is in the early stages of development but shows promising efficacy as a treatment for tumors and VAs in children. Preliminary data suggest favorable responses in children, although direct comparison with adults is limited. Further research is essential to establish standardized treatment guidelines, optimize safety, and define the role of ECT within pediatric oncology and interventional radiology. A minimum reporting dataset is proposed. KEY POINTS: Question Explain the unmet need/clinical problem your study addresses. What is the current evidence regarding indications, efficacy, safety, and treatment parameters of ECT in pediatric patients? Findings Fifteen studies, including 127 children, report high response rates for tumors and VAs, but evidence is limited by small cohorts and heterogeneous reporting. Clinical relevance ECT shows promise as a minimally invasive treatment for selected pediatric tumors and VAs, but standardized protocols and large prospective studies are required before broader clinical adoption in pediatric oncology and interventional radiology.