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 breast and prostate cancers too.
Since 2009, experts in America (for example, at the University of Maryland Medical Center) and in the UK (Professor Edward Leen, Professor of Radiology, Hammersmith Hospital, The Princess Grace Hospital) have been using and studying Irreversible Electroporation, a new technique for treating hard-to-reach, soft tissue tumours (like prostate and pancreatic tumours, for example). The Nanoknife was invented by Gary Onik, a retired interventional radiologist, and is manufactured in America by AngloDynamics as a Medical Device.
It’s not a knife, but it does make nano holes in cancer cells, destroying them. With the Nanoknife, also known as IRE, the process 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 that may otherwise be damaged using other treatments. Unlike ablation where localised high temperatures are used but may give problems if near blood vessels, using a 3000 volt current produces no such side-effects. Ablation also damages the components of the cancer cell, whereas the contents of the cancer cell are unharmed in IRE. They leak into the surrounding tissue rather like bursting a balloon.
How does IRE Work?

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 by the NHS, and they are still running a cost-benefit analysis, so as yet they will not pay for it. Privately, one treatment can cost about 12,000 - 18,000 pounds for pancreatic cancer.

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 tumours and using electrical energy to punch small holes in the cancer cell walls.

IRE destroys tumours using intense bursts of electricity while leaving healthy tissues of the body unharmed. IRE is a minimally invasive procedure and requires no surgical incision.

Side-effects are minimal, although at the outset there was some concern over heart irregularities.
Electricity is applied through probes inserted through the skin. Most usually these are simply two fine needles guided into the correct position either side of 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. The time it takes to place the needles varies based on the size and location of the tumour. Up to 3000 volts is applied between the two needles and this destabilises the whole tumour. Dr Edward Leen talks of it creating nano holes throughout the tumour, causing the cells to leak and die. Healthy cells are outside the area between the two electrodes and remain unharmed.

Because the procedure is considered to be minimally invasive, recovery time may be faster when compared to some other treatments, with some 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.

IRE 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.

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

What Are the Benefits of NanoKnife IRE?
Oncologists now do have the option to treat otherwise inoperable tumours. Patients receive general anesthesia and experience little or no side-effects. 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. 

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.

There are now private clinics in Australia and Germany dealing in cancers such as prostate. 

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 uses the Nanoknife with Liver and Pancreatic cancers according to details from the hospital. His details are on the Internet and he may be contacted on 07900 6966 52
Videos and further details may be found on the Internet and from the hospital.
Hyperthermia as an effective cancer treatment
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