Title : Salvage endoscopic calcium electroporation achieving complete response in recurrent low rectal cancer: A novel organ-preserving approach
Abstract:
Background: Rectal cancer recurrence following non-operative management presents significant treatment challenges, particularly in patients who decline or are unfit for radical surgery. Calcium electroporation (Ca-EP) is an emerging tissue-sparing modality that induces cancer cell death via high-voltage pulses and supraphysiologic calcium influx, without thermal damage.
Case Description: We report a 75-year-old male with recurrent low rectal adenocarcinoma following prior chemoradiotherapy and Papillon contact brachytherapy. The patient declined abdominoperineal resection. Salvage Ca-EP was performed using the EndoVE® probe (Mirai Medical) and ePORE® generator. The 4 cm × 3 cm lesion was injected with calcium gluconate and ablated with 16 pulses of high-voltage electroporation. The patient tolerated the procedure well with minor self-limiting symptoms.
Outcome: Eight-week post-treatment endoscopy revealed complete mucosal healing. Targeted biopsies confirmed complete clinical response with no residual malignancy. At 6 months follow-up, the patient remains symptom-free and disease-free on imaging and endoscopy.
Conclusion: This case highlights salvage Ca-EP as a feasible, organ-preserving option for recurrent low rectal cancer in patients declining surgery. It aligns with the growing trend toward treatment de-escalation in rectal cancer and adds to the expanding evidence base supporting Ca-EP as a promising alternative in select patients.
