NanoKnife IRE

NanoKnife IRE
The Nanoknife IRE is a pioneering treatment which destroys cancer tissue using an electric current but causes no harm to surrounding healthy tissue. It was developed for inoperable tumours in the liver, pancreas, lungs and kidneys, but is now being used for sarcoma, breast and prostate cancers too.
 
Since 2009, experts in America (for example, at the University of Maryland Medical Center) have been using and studying Irreversible Electroporation, a new technique for treating hard-to-reach, and often inoperable soft tissue tumours (for example, liver and pancreatic tumours). 
 
The Nanoknife was invented by Gary Onik, a retired interventional radiologist, and is manufactured in America by AngloDynamics as a Medical Device.
 
What is the Nanoknife IRE?
 
Be clear upfront - It’s not a knife, instead, fine needles are inserted into the body, usually after a small incision. These are placed around the tumour  and then a current of up to 3000 volts is passed across the needles punching holes in the cancer cell walls. This causes the cancer cells to lyse - or leak, losing their contents. That's why it is called Irreversible Electroporation!
 
The Nanoknife IRE is a form of Ablation (localised Hyperthermia) and offers another option for patients who have cancerous tumours that are close to blood vessels, ducts or nerves which may otherwise be damaged using other treatments. Unlike ablation, where localised high temperatures are used and may give problems if near blood vessels, no such side-effects occur with the Nanoknife. Ablation also damages the components of the cancer cell, whereas the contents of the cancer cell are unharmed in IRE. They merely leak into the surrounding tissue, rather like bursting a balloon, to be mopped up by the immune system.
 
Unlike chemo, this is a non-toxic treatment.

Unlike other treatment methods that use thermal ablation - either heating or freezing - to damage the biochemistry of the cancer cell, Irreversible Electroporation, or IRE, works by directly targeting the tumour walls.

Electricity is applied through probes inserted through the skin. Most usually these are simply two or more fine needles guided into the correct position around the tumour. Ultrasound or CT imaging helps doctors guide the placement of the probes precisely. Millisecond electrical pulses are then used between the needles to open the membranes in the cell walls within the tumour. 
 
This irreversible damage causes the cancer cells to die, while nearby nerves, ducts and blood vessels apparently remain unharmed. IRE is performed under general anesthesia. Side-effects are minimal, although at the outset there was some concern over heart irregularities.

Recovery time is usually faster when compared to some other treatments, with minimal soreness from the needles themselves. There is little scarring because of the way IRE causes the cancer cells to open and die, taking advantage of the body’s natural healing ability.
 
Is the Nanoknife IRE 'approved'?

The NanoKnife® IRE System has been commercially available since 2009, and is FDA-approved in America to treat soft tissue tumours. It has not be approved in the UK by the NHS, and they are still running a cost-benefit analysis, so as yet insurers will not pay for it and it is not available on the NHS.

Privately, in the UK, one treatment could cost about £12,000 - 18,000 pounds for pancreatic cancer - Professor Edward Leen, Professor of Radiology, Hammersmith Hospital, The Princess Grace Hospital was the main force behind the treatment but he met with so much negativity from surgeons and others he has now stopped providing the service and retired.

Apparently, Professor Mark Emberton at UCH has been studying it for prostate cancer, and the UK Pancreatic charity talk about it, but in a negative way. 

IRE also boosts the immune system

When using Irreversible Electroporation, the cytoplasm of cancer cells flows out through the small holes created. One huge beneficial side-effect has now been shown. As the tumour disintegrates, large numbers of tumour proteins are released into the body into the lymph system. In prostate cancer, these have been shown to arrive at the lymph nodes causing a massive immune response. All tumours cause micro-metastases in the body. The immune response then knocks these out, giving the Nanoknife IRE a second crucial benefit. 
 
What Types of Cancer Can Be Treated with IRE?
 
IRE can be used to treat many types of otherwise inoperable soft tissue tumors. Doctors in UMMC’s Department of Interventional Radiology are using IRE to treat primary and metastatic liver cancer, as well as soft tissue tumours in the lung, prostate, breast, head and neck, kidney and pancreas. Other centres also treat colorectal, sarcoma, stromal wall, melanoma and stomach.

In the UK the treatment is being studied alongside HIFU and other Ablation treatments, but slowly.

What are the Benefits of NanoKnife IRE and how do you get it?
 
Oncologists now do have the option to treat otherwise inoperable tumours. Patients receive general anesthesia and experience little or no side-effects. The treatment is non-toxic. The treatment requires only a brief stay in the hospital, usually overnight. The procedure can be repeated if new tumours occur.

Of course, as it is more widely used, so it will become more regularly used on prostate and even breast cancer. The ability to deal with micro-metastases all over the body is a real plus over conventional surgery. 
 
In Europe, The Vitus Clinic uses the Nanoknife for Prostate cancer successfully
 
In Hollywood, Florida, Dr. Robert Donoway uses Nanoknife for more than ten types of cancer at the Atlas Oncology Clinic.
 
In Australia, the Nanoknife is available by former Surgeon Dr. Robert Gandy, at the Prince of Wales Hospitals, and by Dr. Koroush Haghighi at the Nanoknife Metropolitan Sydney. 

Hospitals in the US using the treatment include University of Florida, University of Louisville and the Baptist Health Medical Centre in Little Rock, Ark. Over 2000 patients have been treated. Anecdotal evidence is very positive.

However, there are no Clinical Trials, held or planned. Needless to say, a number of major cancer centres in America (and particularly their surgeons, and the pharmaceutical companies) have expressed concerns about the lack of clinical evidence.

Professor Edward Leen is Professor of Radiology at the faculty of Medicine at Imperial College London and based on the Hammersmith Hospital Campus. He used the Nanoknife with Liver and Pancreatic cancers and breast and ovarian tumours. He has now retired.
 
In the UK, yet again it seems we fall behind the world in new ideas for non-drug cancer treatments.
 
Hyperthermia as an effective cancer treatment
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