{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T14:03:05Z","timestamp":1780322585576,"version":"3.54.1"},"reference-count":46,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Bone involvement is a common and debilitating manifestation of advanced malignancies, with a substantial negative impact on patients\u2019 functional status, quality of life, and overall prognosis. Management is primarily palliative and may include several locoregional approaches such as radiotherapy, surgical stabilization, cementoplasty, thermal or cryoablation, and high-intensity focused ultrasound. Electrochemotherapy (ECT) is an emerging non-thermal ablative technique that combines limited invasiveness with short procedural times and a favorable safety profile. Case Presentation: We report the case of a patient with oligometastatic lung cancer presenting with a painful rib metastasis refractory to radiotherapy. The patient had previously undergone radiotherapy to the right femoral head and the eighth rib, followed by cryoablation combined with cementoplasty for the femoral lesion and cryoablation of the rib. At one-year follow-up after cryoablation combined with bone cementoplasty, computed tomography demonstrated progression with the appearance of a new symptomatic rib lesion unresponsive to further radiotherapy. Percutaneous ECT was therefore performed under general anesthesia, supplemented with an erector spinae plane block. A total of twelve 18-gauge needle electrodes were accurately positioned under fluoroscopic guidance. Follow-up imaging at three months showed complete local tumor resolution, accompanied by marked and sustained pain relief. Conclusions: This experience supports the role of ECT as an effective salvage locoregional treatment option in selected patients with bone metastases resistant to conventional therapies.<\/jats:p>","DOI":"10.3390\/reports9020172","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T12:19:42Z","timestamp":1780316382000},"page":"172","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Locoregional Treatment of Bone Metastases in a Lung Cancer Patient: A Case Report Using Multiple Techniques: Electrochemotherapy, Cryoablation, and Cementoplasty"],"prefix":"10.3390","volume":"9","author":[{"given":"Francesco","family":"Fiore","sequence":"first","affiliation":[{"name":"Division of Interventional Radiology, Istituto Nazionale per lo Studio e la Cura dei Tumori \u201cFondazione G. Pascale\u201d, IRCCS of Naples, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3295-840X","authenticated-orcid":false,"given":"Salvatore","family":"Stilo","sequence":"additional","affiliation":[{"name":"Division of Interventional Radiology, Istituto Nazionale per lo Studio e la Cura dei Tumori \u201cFondazione G. Pascale\u201d, IRCCS of Naples, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Tarotto","sequence":"additional","affiliation":[{"name":"Division of Interventional Radiology, Istituto Nazionale per lo Studio e la Cura dei Tumori \u201cFondazione G. Pascale\u201d, IRCCS of Naples, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"Federico","sequence":"additional","affiliation":[{"name":"Division of Radiology, Universit\u00e0 Degli Studi di Napoli Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noemi","family":"Brignola","sequence":"additional","affiliation":[{"name":"Division of Radiology, Universit\u00e0 Degli Studi di Napoli Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3075-7201","authenticated-orcid":false,"given":"Gaetano","family":"Sicuranza","sequence":"additional","affiliation":[{"name":"Division of Radiology, AOU Citt\u00e0 Della Salute Torino, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"D\u2019Angelo","sequence":"additional","affiliation":[{"name":"Division of Interventional Radiology, Istituto Nazionale per lo Studio e la Cura dei Tumori \u201cFondazione G. Pascale\u201d, IRCCS of Naples, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3694","DOI":"10.1002\/1097-0142(19931215)72:12<3694::AID-CNCR2820721222>3.0.CO;2-2","article-title":"Electrochemotherapy, a new anti tumor treatment. First clinical phase I\u2013II trial","volume":"72","author":"Belehradek","year":"1993","journal-title":"Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.ejcsup.2006.08.005","article-title":"Bases and rationale of the electrochemotherapy","volume":"4","author":"Mir","year":"2006","journal-title":"Eur. J. Cancer Suppl."},{"key":"ref_3","first-page":"613","article-title":"Electrochemotherapy, a new anti tumor treatment: First clinical trial","volume":"313","author":"Mir","year":"1991","journal-title":"C. R. Acad. Sci. III"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ejcsup.2006.08.002","article-title":"Electrochemotherapy\u2014An easy, highly effective and safe treatment of cutaneous and subcutaneous metastases. Results of ESOPE (European Standard Operating Procedures of Electrochemotherapy) study","volume":"4","author":"Marty","year":"2006","journal-title":"Eur. J. Cancer Suppl."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.ejcsup.2006.08.003","article-title":"Standard operating procedures of the Electrochemotherapy: Instructions for the use of bleomycin or cisplatin administered either systemically or locally and electric pulses delivered by the Cliniporator by means of invasive or noninvasive electrodes","volume":"4","author":"Mir","year":"2006","journal-title":"Eur. J. Cancer Suppl."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1080\/0284186X.2018.1454602","article-title":"Updated standard operating procedures for electrochemotherapy of cutaneous tumours and skin metastases","volume":"57","author":"Gehl","year":"2018","journal-title":"Acta Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1245\/s10434-008-0204-8","article-title":"Bleomycin-Based Electrochemotherapy: Clinical Outcome from a Single Institution\u2019s Experience with 52 Patients","volume":"16","author":"Campana","year":"2008","journal-title":"Ann. Surg. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1097\/AJP.0000000000000255","article-title":"Modern palliative treatments for metastatic bone disease: Awareness of merits, demerits and guidance","volume":"32","author":"Mavrogenis","year":"2016","journal-title":"Clin. J. Pain."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Granata, V., Fusco, R., Salati, S., Petrillo, A., Di Bernardo, E., Grassi, R., Palaia, R., Danti, G., La Porta, M., and Cadossi, M. (2021). A Systematic Review about Imaging and Histopathological Findings for Detecting and Evaluating Electroporation Based Treatments Response. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18115592"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1302\/0301-620X.92B11.24664","article-title":"Ablation of bone cells by electroporation","volume":"92","author":"Fini","year":"2010","journal-title":"Bone Jt. Surg. Br."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"E1340","DOI":"10.1097\/BRS.0000000000001125","article-title":"Electrochemotherapy to Metastatic Spinal Melanoma","volume":"40","author":"Gasbarrini","year":"2015","journal-title":"Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1007\/s00270-025-04077-9","article-title":"Electrochemotherapy in the Treatment of Bone Metastases: A Narrative Review","volume":"48","author":"Feddal","year":"2025","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1806","DOI":"10.1007\/s00270-019-02316-4","article-title":"Percutaneous Image-Guided Electrochemotherapy of Spine Metastases: Initial Experience","volume":"42","author":"Cornelis","year":"2019","journal-title":"Cardiovasc. Radiol."},{"key":"ref_14","first-page":"1518","article-title":"Metastatic bone disease: Diagnosis, evaluation, and treatment","volume":"91","author":"Biermann","year":"2009","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.ejca.2023.03.012","article-title":"Electrochemotherapy in radiotherapy-resistant epidural spinal cord compression in metastatic cancer patients","volume":"186","author":"Deschamps","year":"2023","journal-title":"Eur. J. Cancer"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Granata, V., Fusco, R., D\u2019Alessio, V., Simonetti, I., Grassi, F., Silvestro, L., Palaia, R., Belli, A., Patrone, R., and Piccirillo, M. (2023). Percutanous Electrochemotherapy (ECT) in Primary and Secondary Liver Malignancies: A Systematic Review. Diagnostics, 13.","DOI":"10.3390\/diagnostics13020209"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1093\/bjr\/tqae219","article-title":"Electrochemotherapy in metastatic epidural spinal cord compression: A review and technical update","volume":"98","author":"Deschamps","year":"2025","journal-title":"Br. J. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1016\/j.addr.2004.12.014","article-title":"Targeting of therapeutic agents to bone to treat metastatic cancer","volume":"57","author":"Bagi","year":"2005","journal-title":"Adv. Drug Deliv. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"4373","DOI":"10.1200\/JCO.2008.17.6156","article-title":"Raising the profile of cancer of unknown primary","volume":"26","author":"Oien","year":"2008","journal-title":"J. Clin. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.1002\/cncr.20202","article-title":"Diagnostic strategies for unknown primary cancer","volume":"100","author":"Varadhachary","year":"2004","journal-title":"Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1007\/s10585-013-9601-x","article-title":"Electrochemotherapy is effective in the treatment of rat bone metastases","volume":"30","author":"Fini","year":"2013","journal-title":"Clin. Exp. Metastasis"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1007\/s00232-010-9274-1","article-title":"Robustness of treatment planning for electrochemotherapy of deep seated tumors","volume":"236","author":"Kos","year":"2010","journal-title":"J. Membr. Biol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Bianchi, G., Campanacci, L., Rimondi, E., and Ruggieri, P. (2012). Palliative treatments: Electroche-motherapy and thermoablation. Advances in Bone Metastasis, Future Medicine Ltd.","DOI":"10.2217\/ebo.11.362"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3088","DOI":"10.1007\/s00268-016-3627-6","article-title":"Electrochemotherapy in the Treatment of Bone Metastases: A Phase II Trial","volume":"40","author":"Bianchi","year":"2016","journal-title":"World J. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1007\/s00268-013-2321-1","article-title":"Electrochemotherapy treatment of locally advanced and metastatic soft tissue sarcomas: Results of a non-comparative phase II study","volume":"38","author":"Campana","year":"2014","journal-title":"World J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1177\/1533034615604454","article-title":"Feasibility of Electroporation in Bone and in the Surrounding Clinically Relevant Structures: A Preclinical Investigation","volume":"15","author":"Tschon","year":"2015","journal-title":"Technol. Cancer Res. Treat."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2609","DOI":"10.1016\/j.ejso.2021.05.004","article-title":"Operating procedures for electrochemotherapy in bone metastases: Results from a multicenter prospective study on 102 patients","volume":"47","author":"Campanacci","year":"2021","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3347","DOI":"10.3390\/curroncol28050290","article-title":"Current Overview of Treatment for Metastatic Bone Disease","volume":"28","author":"Tsukamoto","year":"2021","journal-title":"Curr. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.3390\/curroncol29030139","article-title":"Electrochemotherapy Is Effective in the Treatment of Bone Metastases","volume":"29","author":"Campanacci","year":"2022","journal-title":"Curr. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1533034618770253","DOI":"10.1177\/1533034618770253","article-title":"Electrochemotherapy of Spinal Metastases Using Transpedicular Approach-A Numerical Feasibility Study","volume":"17","author":"Kos","year":"2018","journal-title":"Technol. Cancer Res. Treat."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1038\/nrc747","article-title":"Molecular mechanisms of cancer pain","volume":"2","author":"Mantyh","year":"2002","journal-title":"Nat. Rev. Cancer"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"6231s","DOI":"10.1158\/1078-0432.CCR-06-0682","article-title":"Biology of bone cancer pain","volume":"12","author":"Goblirsch","year":"2006","journal-title":"Clin. Cancer Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1053\/j.seminoncol.2004.11.018","article-title":"The expanding role of interventional radiology in the supportive care of the oncology patient: From diagnosis to therapy","volume":"32","author":"Coldwell","year":"2005","journal-title":"Semin. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1684\/bdc.2013.1843","article-title":"Radiologie interventionnelle des m\u00e9tastases osseuses Interventional radiology for bone metastases","volume":"100","author":"Iannessi","year":"2013","journal-title":"Bull. Cancer"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1055\/s-0030-1253511","article-title":"Percutaneous bone tumor management","volume":"27","author":"Gangi","year":"2010","journal-title":"Semin. Interv. Radiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.jvir.2007.09.016","article-title":"Radiofrequency ablation in combination with osteoplasty in the treatment of painful metastatic bone disease","volume":"19","author":"Hoffmann","year":"2008","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1016\/j.jvir.2009.03.035","article-title":"Combined cementoplasty and radiofrequency ablation in the treatment of painful neoplastic lesions of bone","volume":"20","author":"Munk","year":"2009","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1148\/radiology.199.1.8633152","article-title":"Spinal metastases: Indications for and results of percutaneous injection of acrylic surgical cement","volume":"199","author":"Weill","year":"1996","journal-title":"Radiology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1016\/j.jvir.2008.08.014","article-title":"CT fluoroscopy-guided percutaneous vertebroplasty for the treatment of osteolytic breast cancer metastases: Results in 62 sessions with 86 vertebrae treated","volume":"19","author":"Trumm","year":"2008","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_40","unstructured":"Ontario, Health Quality (2016). Vertebral Augmentation Involving Vertebroplasty or Kyphoplasty for Cancer-Related Vertebral Compression Fractures: A Systematic Review. Ont. Health Technol. Assess. Ser., 16, 1\u2013202."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/j.jvir.2007.02.018","article-title":"Treatment of vertebral tumor with posterior wall defect using image-guided radiofrequency ablation combined with vertebroplasty: Preliminary results in 12 patients","volume":"18","author":"Kroft","year":"2007","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1148\/radiol.09081698","article-title":"Percutaneous vertebroplasty for pain management in malignant fractures of the spine with epidural involvement","volume":"254","author":"Saliou","year":"2010","journal-title":"Radiology"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"759","DOI":"10.3174\/ajnr.A4595","article-title":"Radiographic Local Control of Spinal Metastases with Percutaneous Radiofrequency Ablation and Vertebral Augmentation","volume":"37","author":"Wallace","year":"2016","journal-title":"Am. J. Neuroradiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1080\/02656736.2019.1613573","article-title":"Percutaneous minimally invasive thermal ablation for management of osseous metastases: Recent advances","volume":"36","author":"Tomasian","year":"2019","journal-title":"Int. J. Hyperth."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s11547-021-01437-6","article-title":"CT-guided cryoablation for management of bone metastases: A single center experience and review of the literature","volume":"127","author":"Arrigoni","year":"2022","journal-title":"Radiol. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"S187","DOI":"10.1016\/j.jvir.2009.12.403","article-title":"Cryoablation: Mechanism of Action and Devices","volume":"21","author":"Erinjeri","year":"2010","journal-title":"J. Vasc. Interv. Radiol."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/2\/172\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T13:01:49Z","timestamp":1780318909000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/2\/172"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,1]]},"references-count":46,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["reports9020172"],"URL":"https:\/\/doi.org\/10.3390\/reports9020172","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,1]]}}}