Preface
The pancreas is a retroperitoneal organ in the human body with insidious onset and difficult early detection. At the time of tumor diagnosis, only 10%-20% of patients have access to radical surgery, 30%-40% of patients have locally advanced tumor status, and 50%-60% of patients have developed distant tumor metastases. According to the Global Cancer Statistics Report 2018, the overall survival rate of pancreatic cancer has not improved significantly in the last 30 years, and the 5-year survival rate is even lower than 7%, but the incidence is increasing. In recent years, several treatments have been proposed for locally progressive pancreatic cancer, and irreversible electroporation ablation therapy is one of them. Irreversible Electroporation also known as Nanoknife is a new non-thermal physical ablation technique.
The purpose of quoting part of the article here is to highlight the significant advantages of irreversible electroporation technology, so that readers can have a clearer understanding of Nanoknife and understand the breakthrough and important role of Nanoknife ablation surgery in the treatment of locally progressive pancreatic cancer.
Image-guided Irreversible Electroporation for Locally Progressive Pancreatic Cancer
Chen Jiao, Li Tao, Song Jiarui, Yang Hanfeng
Modern Digestion&Intervention2021,V01.26,No.4
[Department of Radiology, Affiliated Hospital of Chuanbei Medical College]
Abstract
Pancreatic cancer is a neoplastic disease with an insidious onset and a high degree of malignancy. Most patients are clinically at the stage of inoperable resection at the time of diagnosis. Local treatment to control the tumor growth and prolong the patient's survival is the main goal of this stage of treatment. Irreversible electroporation, as a minimally invasive ablation technique for tumors, causes apoptosis in the ablation zone while well protecting the integrity of the cellular stroma of surrounding vessels, bile ducts and pancreatic ducts, and is gradually showing advantages in the treatment of progressive pancreatic cancer.Here,we review the imaging-guided irreversible electroporation for the treatment of locally progressive pancreatic cancer.
IRE Fundamentals and Benefits
When the cell is in a pulsed electric field, the phospholipid bilayer on the cell membrane will produce nanoscale holes under the electric field, and when the electric field strength increases to a certain level, the holes produced in the cell membrane will not recover, thus causing the destruction of the intracellular environment and leading to cell death. iRE is based on such a principle, where a short and high pulsed voltage is applied between two electrodes made of special materials, so that the cell The original membrane potential is altered, creating irreversible nanoscale pores in the lipid bilayer of the membrane, causing a disruption of cellular homeostasis and thus cell death. This ablation method only causes cell death in a specific area, while preserving the integrity of the tissue scaffold and fibrous structure of the cells, while the adjacent tissues (e.g., blood vessels or surrounding normal tissues) are not damaged, avoiding the "heat sink effect" in the ablation area and facilitating the repair of the organism. IRE can achieve local lesion ablation by disrupting cellular homeostasis, so as to destroy tumor or control tumor growth. After IRE treatment, the antigen of autologous tumor cells flows to the extracellular area, and the antigen stimulates the immune response of the body, which can improve the anti-tumor efficacy of the body.
Advantages and disadvantages of IRE for pancreatic cancer
IRE has unique advantages over traditional ablation methods such as radiofrequency, freezing and microwave: (1) the boundary between the ablation zone and the non-ablation zone is clear, and the cells in the ablation zone are destroyed and die, but there is no damage to the tissues outside the ablation zone; (2) precise control, during the operation, the degree of ablation is judged in real time according to the current waveform, ensuring the completeness of ablation and also avoiding excessive ablation; (3) the duration of ablation is short. facilitates rapid postoperative recovery and reduces the patient's hospitalization time. ④ Strong selectivity for ablated tissues and cells, and basically no effect on elastic fibers, collagen fibers and cellular matrix in the ablation area, which can effectively protect the surrounding blood vessels, bile ducts and other important tissues; ⑤ IRE can cause physiological cell death in the ablation area, which avoids the simultaneous necrosis of a large number of tissues at one time and aggravates the immune burden of the body; ⑥ The specific antigen outflow of the tumor after IRE ablation can activate the body's immune system, which helps the body to respond to the ablation. (6) the tumor-specific antigen outflow after IRE ablation can activate the immune system of the body and help the body to control the tumor.
Complications after IRE for pancreatic cancer include infection, arrhythmia, vascular complications (thrombosis, vascular stenosis/compression or occlusion), pancreatitis and pancreatic leakage, nausea and vomiting, bleeding and ascites. The main cause of arrhythmias is the excitation of skeletal and cardiac muscle caused by the high voltage DC pulses used in IRE. IRE should be used with caution in patients with arrhythmias, and the patient's heart rate must be noted during surgical treatment. Complicated bleeding is mostly due to gastrointestinal bleeding due to lesions located in the head of the pancreas and the ablation area near the duodenum, causing duodenal ulceration, which can mostly be relieved with symptomatic treatment.
A systematic evaluation published in 2019 reviewed the outcome of 691 patients with unresectable locally progressive pancreatic cancer treated with IRE and found that the complication rate was around 30%, and all of them could be relieved by aggressive postoperative treatment; the cumulative mortality rate after IRE was 3.4%, and the median time to survival was 27 months; in addition, IRE could effectively control pain.
Domestic scholars analyzed the perioperative complications of 200 IRE-treated tumor patients; most of them were common mild complications, and only 5 cases showed more serious complications (gastrointestinal bleeding and biliary system infection), and all patients' complication symptoms were relieved by symptomatic treatment.
In conclusion, imaging-guided IRE ablation as a local treatment option for tumors, which uses pulsed voltage to increase cell membrane permeability to induce cell death, has shown excellent ablative effects in animal models. In recent years, it has been continuously applied in human solid tumors, especially in localized progressive pancreatic cancer, showing a broad application prospect and bringing hope to patients with progressive pancreatic cancer. Although some complications may occur after treatment, it can generally prolong the survival time and improve the quality of life of patients.
Currently, a multi-center clinical registration trial of the Steep Pulse Therapeutic Apparatus (Nanoknife) for the ablation treatment of pancreatic malignant tumors is underway in several hospitals across the country. For more information, please leave a message in the background or contact the following person by phone.
Contact person:Manage Zuo from Alpmed
Tel:022-23788188 Ext 7206
Membership
