INNOVATIVE TECHNICAL irreversible electroporation treatment of liver and pancreatic tumors
This technique, which represents significant progress in the treatment of cancer, has already been used in three cases in HM University Sanchinarro, representing the best national series, and so far there have been six cases in Spain electroporation in liver tumors pancreáticosCon irreversible electroporation and non thermal energy and creates countless permanent nanopores in the cell membrane to prevent homeostasis, initiating cell death by apoptosisEsta technique is used in the treatment of digestive tumors (pancreatic or hepatic), kidney, prostate and lung, focusing its main indication in the first two citadosEste procedure, like many others that take place in the centers of HM hospitals reflects the existing cooperative and multidisciplinary between different specialties; in cases treated in HMS with irreversible electroporation attended services of Oncology, Radiology and GeneralFacilities Surgery main advantages of this technique are the immune response from the patient, including phagocytosis of the contents of dead cells and "clean" the post area -ablación, resulting in a quick recovery and regeneration of the treated area; and its ability to preserve vital structures within the ablated area
Madrid, September 24, 2013. HM Hospital has taken another step in the innovative approach of liver and pancreatic tumors with the addition to its portfolio of irreversible electroporation, a technique that uses non-thermal energy for ablation tumors, allowing preserve vital structures within the ablated area. This technique, which represents significant progress in the treatment of cancer and is available in very few hospitals worldwide number has already been used to treat three patients in HM University Sanchinarro (HMS) since last month July, reaching these cases made the top ten in Spain in this type of pathology, say the doctors Vicente Emilio and Yolanda Quijano, responsible for the Department of General Surgery and Digestive HMS; and Dr. Avertano Wall, Chief of Radiology at the same hospital.
Irreversible electroporation with non thermal energy is used to create many and permanent nanopores in the cell membrane in order to prevent homeostasis, thereby initiating cell death by apoptosis. The system consists of an automated generator to which you can connect up to six monopolar electrodes along with an electrocardiograph that connects to the patient's heart rhythm to synchronize the shock, avoiding the possibility of arrhythmias.
"The electrodes are placed on the treatment area, with a distance between them of between 1.5 and 2 cm, to create the necessary electric field for treatment," said the expert, adding that the energy produced does not burn and preserves tissues and non-cellular structures. After placement, rapid series of short pulses (90 mS) with a high voltage direct current (70 A) are applied, the total power ranging between each pair of electrodes between 1,500 and 3,000 volts, which causes cell death by apoptosis in the ablated zone.
According to Dr. Wall, the electrodes can be placed and controlled in real time with CT or ultrasound guidance, and the technique allows "producing a very precise ablation area at the cellular level, no transition zone", as the software used in this procedure calculates the ablation zone programmed with information entered on the positioning of the needles and the size and surface of the tumor.
This novel technique is used in the treatment of digestive tumors (liver or pancreas), kidney, prostate and lung, focusing its main indication in the first two mentioned tumors. For patients with irreversible electroporation in HMS, were indications of colorectal liver metastatic tumors originated from two cases, and a primary pancreatic tumor in the third; none was considered surgically resectable.
"The three procedures were performed without major incidents and patients were discharged during the first week of post-operative" assert those responsible for the Department of General Surgery and Digestive HMS, making a "very satisfactory" balance of these three first cases, which are "the best national series, and so far there have been six cases in Spain electroporation in liver and pancreatic tumors, of which half have done us all."
Extensive multidisciplinary treatment options and treatment
In his view, this is an obvious explanation: "The special features of our hospital and the special definition for the treatment of tumor processes causes the volume of patients treated for digestive tumors is very high, for which it has one of the largest portfolios of therapeutic services that currently can have in the world, "they say. And added: "The strength of a hospital is reflected in many ways; one of them is, without doubt, the absence of therapeutic limitations, both technically and technologically, so that the patient can be treated individually and directed to the most appropriate treatment; our hospital has different types of treatment for these processes: radiosurgery, radiofrequency, alcohol injection and chemoembolization, and the aforementioned procedure is complete therapeutic range ".
In addition, this procedure, like many others that take place in the centers of HM hospitals reflects the existing "cooperative nature" between the different specialties. And, like the other patients in the group, all patients suffering from liver and pancreatic tumors are treated in a multidisciplinary way, and their cases are discussed in a general session where more than 25 different specialists assess and analyze the characteristics of clinical case and line design therapeutic effect.
Thus, irreversible electroporation services Oncology, Radiology and General Surgery involved. From a practical standpoint, the procedure is performed by the Radiology Service, in collaboration with the General Surgery, which is still very common, as other intraoperative diagnostic and therapeutic procedures are performed with the same degree of collaboration and commitment.
Advantages of the technique
As for the advantages of cell death by apoptosis created irreversible electroporation, Vicente and doctors Quijano include "the patient's own immune response, including phagocytosis content dead cells and" clean "post-ablation area , resulting in a faster recovery and regeneration of the treated area, since apoptosis is simply part of the natural process of cell cycle ".
Also they emphasize the unique feature of this technique makes it different from other ablation techniques: its ability to preserve vital structures within the ablated area. "This only affects the cell membrane, and not to any other structure in the tissue (nerves, blood vessels and all collagen structures), which are no damage," state. Here, still, when using a non-thermal ablation method, you can treat lesions in proximity of vital, such as major blood vessels and bile ducts structures. "The vascular endothelium regenerates two days and smooth muscle two weeks," they insist, stressing that the procedure can be repeated several times and, since there is no necrosis in the treated tissue, and "not committed any other type treatment, if used as first choice. "
"It is a particularly advantageous process for patients who do not have an effective surgical alternative, and the patient usually has minimal post-treatment pain," he added.
In particular, such ablative therapy may be performed in hepatic and pancreatic selected primary or secondary tumors, up to about 4.3 cm long patients, and to be non-thermal, can be effected by open or percutaneously (using ultrasound or CT). On the contrary, it is contraindicated in the ablation of lesions in the thoracic area in the presence of cardiac implants, pacemakers or defibrillators, ablation of lesions near implanted electronic devices or implanted metal parts devices, or patients with a history of epilepsy, arrhythmias heart disease or recent history of myocardial infarction.