Irreversible Electroporation (IRE) With NanoKnife Technology May Provide Cure for Pancreatic Cancer

A more targeted treatment for cancer cells may be the answer to complicated and inoperable diseases like pancreatic cancer.

Irreversible Electroporation (IRE) is a new minimally invasive technique to treat soft tissue tumors in the liver, lung, prostate, head and neck, kidney and pancreas. It proves a safe option for patients who may have cancerous tumors near blood vessels, ducts or nerves that may otherwise be damaged using other techniques, such as burning through radio frequency/microwave ablation, freezing through cryotherapy or traditional open surgery.

IRE uses electrical energy to target tumors at the cellular level. Using short electrical pulses, IRE breaks open the tumor cell walls, causing the cancer cells to die. The key difference with IRE compared to other treatments is that this electrical field does not produce extreme heat or cold. It may selectively damage the cancerous cells, sparing healthy tissue and structures that may be nearby allowing a more targeted treatment.

Results of a study presented at the Society of Interventional Radiology's 37th Annual Scientific Meeting in San Francisco, Calif., signal a light at the end of the tunnel for individuals with inoperable locally advanced pancreatic cancer (LAPC). A new procedure called irreversible electroporation or IRE uses microsecond electrical pulses to force open and destroy tumor cells around a vast and delicate network of blood vessels of the pancreas. The technique has been successful in treating primary and metastatic liver cancer and IRE is now in the first stages of implementation as a treatment for pancreatic cancer.

"We think in another 12 to 15 months we will have a lot more evidence to support the use of IRE for inoperable pancreatic cancer patients," said Govindarajan Narayanan, M.D., chief of vascular and interventional radiology, associate professor of clinical radiology and program director for the vascular interventional radiology fellowship at the University of Miami's Miller School of Medicine in Miami, Fla. "If we continue to get good results, this procedure could provide a huge benefit for people who honestly don't have a lot of choices. It could potentially change the rules of how these cases are managed," he added.

Pancreatic tumors are notoriously difficult to treat because any method that uses heat or cold to remove the cancer comes with too much risk of collateral damage to important blood vessels in and around the organ. IRE involves guiding electrode needles into the tumor, which gives cancer cells a series of jolts of localized high-voltage electricity that break open the cell membranes, effectively killing the cancerous tissues around these blood vessels.

Video: Irreversible Electroporation with NanoKnife Technology

"People with locally advanced pancreatic cancer don't have a lot of treatment choices available. Irreversible electroporation gives these individuals a new treatment option and a potentially greater chance of survival," said Narayanan. "Without IRE, these people are essentially left with chemotherapy and radiation therapy. At this point the prognosis for this group is pretty dismal and they have an estimated survival of less than one year. With this procedure, there is the potential to have the tumor peeled off the blood vessels, and follow up treatment to repair the affected area of the pancreas," he noted.

According to the American Cancer Society, an estimated 43,920 people will be diagnosed with pancreatic cancer and approximately 37,390 people will die of the disease this year. About one in 71 people are expected to develop pancreatic cancer in their lifetime.

For this study, researchers gathered records for eight patients with locally advanced pancreatic cancer referred for percutaneous irreversible electroporation. All subjects had the procedure performed between December 2010 and September 2011. Pancreatic tumors were found to be between 2.5 and 6.8 centimeters in size and each participant had formerly received a median of two other methods of treatment. A median span of time of about 9 months took place between diagnosis and treatment with IRE. Participants underwent post-procedure CT imaging to gauge the effectiveness of treatment. Out of the original eight inoperable individuals, two went on to have surgery. Both had successful resections and remain cancer-free after months following treatment.

IRE is performed with a technology dubbed NanoKnife, which has received clearance from the U.S. Food and Drug Administration for the surgical ablation of soft tissue.

"As we move forward there will be a lot of new technology and techniques like this that will help shape cancer care," said Narayanan.

About the Society of Interventional Radiology

Interventional radiologists are physicians who specialize in minimally invasive, targeted treatments. They offer the most in-depth knowledge of the least invasive treatments available coupled with diagnostic and clinical experience across all specialties. They use X-ray, MRI and other imaging to advance a catheter in the body, such as in an artery, to treat at the source of the disease internally. As the inventors of angioplasty and the catheter-delivered stent, which were first used in the legs to treat peripheral arterial disease, interventional radiologists pioneered minimally invasive modern medicine. Today, interventional oncology is a growing specialty area of interventional radiology. Interventional radiologists can deliver treatments for cancer directly to the tumor without significant side effects or damage to nearby normal tissue. Many conditions that once required surgery can be treated less invasively by interventional radiologists. Interventional radiology treatments offer less risk, less pain and less recovery time compared to open surgery.

Quantum Day

26 March 2012

Irreversible Electroporation (IRE) With NanoKnife Technology May Provide Cure for Pancreatic Cancer