Combined treatment for nonmetastatic, inoperable (locally advanced) pancreatic cancer: chemotherapy, radiotherapy, surgery and Nanoknife

Among all cancers, pancreatic cancer is one of the most challenging tumor groups to treat. We rarely encounter early-stage pancreatic cancer, and surgery alone is sufficient for most of these cases. If certain risk factors are present, chemotherapy and/or radiotherapy after surgery can prolong survival and completely save some patients' lives. However, pancreatic cancer is usually beyond operable limits when diagnosed. Today's study concerns successful results from a combined treatment including a procedure called Nanoknife in pancreatic cancer inoperable because of local advancement.

The pancreas occupies a critical location immediately surrounded by major vessels and neighboring organs. Surgery becomes impossible particularly when cancer encases major vessels or contacts and extends into them (invasion), meaning vascular involvement. Chemotherapy and radiotherapy are then the main options. Despite very new regimens and advances in radiotherapy techniques, survival in locally advanced pancreatic cancer still has not extended beyond 1 year.

An article published in September 2015 in Annals of Surgery, a respected surgical journal, gave us a ray of hope. In this study, irreversible (permanent) electroporation (Nanoknife) , a high-voltage electrical treatment applied during surgery, produced almost extraordinary survival. This success profoundly impressed the oncology community, particularly regarding pancreatic cancer. We have been performing Nanoknife since approximately 2011, successfully using it at our clinic to regress disease and relieve pain in pancreatic cancer patients. For our work in 2011 and 2012, we received awards at interventional radiology congresses 2 times. Being so involved in this subject, seeing a study showing extraordinarily prolonged survival in more than 200 patients deeply excited my team and me.

Nanoknife in pancreatic cancer (Irreversible Electroporation = İRE)

In this interventional radiology method, performed under general anesthesia with ultrasound or CT guidance, 4 needles are placed in the tumor area and very high electrical current is applied. This irreversibly increases cancer cell membrane permeability, and the cells lose viability. The method causes a slow tissue death called apoptosis . While living cells in the treated area die, connective-tissue structures such as vessels and nerves are largely preserved. Nanoknife aims to regress pancreatic tumors, thereby both reducing complaints and prolonging survival.

However, the study discussed here took this goal further. The team first gave these patients tumor-shrinking treatments (chemotherapy and/or radiotherapy). They were reassessed afterward, and responders underwent surgical tumor removal and Nanoknife. Nanoknife was applied to areas not completely removable surgically, greatly extending the operation's success. One group responding very well to initial treatment even received Nanoknife alone during surgery. Patients were followed for an average of 3 years, achieving survival exceeding almost 2 years, a very good duration for locally advanced pancreatic cancer in current medicine. To watch an animation of Nanoknife (Irreversible Electroporation = İRE), you can click here.