In the Clinic

On Cancer: Poking Holes in Cancer — One Electric Current at a Time

By Jim Stallard, MA, Writer/Editor  |  Monday, January 27, 2014
Pictured: Stephen Solomon Interventional Radiologist Stephen Solomon

Cancer researchers constantly strive to expand the arsenal of weapons to treat the disease, particularly for people with tumors that aren’t responsive to conventional treatments. One such option is a minimally invasive approach called thermal ablation, which involves placing a needle into a tumor and applying extreme heat or cold, which kills the cancer while preserving healthy tissue. In addition to destroying tumors, thermal ablation may actually activate immune cells to attack the cancer.

Memorial Sloan Kettering now has one of the biggest ablation programs in the United States, says Stephen Solomon, Chief of the Interventional Radiology Service and Director of the Center for Image-Guided Interventions. “We’re treating approximately 300 people a year, frequently on an outpatient basis that allows patients to go home after the procedure the same day.”

However, thermal ablation cannot be used in some patients.

“Thermal ablation can cause scarring in healthy tissue near the tumor, making it inappropriate for use on some tumors near blood vessels, nerves, bile ducts, and other sensitive structures,” says Mikhail Silk, a medical student at SUNY Downstate College of Medicine, in Brooklyn, who is conducting research in collaboration with the Interventional Radiology Service. “It also can fail to kill every cancer cell if the tumor abuts a major blood vessel because blood flow dissipates some of the extreme heat or cold emitted from the needle — a phenomenon called the heat sink effect.”

Punching Holes in Cells

Now a new, minimally invasive treatment that uses an electric current to punch tiny holes in cancer cell membranes is showing promise against challenging tumors. Called irreversible electroporation (IRE), the technique uses tiny needles to give cancer cells a jolt of electricity. 

The electricity produces holes in the cell membranes, which disrupts the balance of molecules inside and outside the cells. IRE causes no scarring or inflammation in nearby healthy tissues, and there is no heat sink effect.

“Blood vessels and nerves are made not just of cells but also have protein structures surrounding them,” Dr. Solomon explains. “Because proteins don’t have electric membrane potential, these structures are largely protected from IRE, making it possible to destroy a tumor safely without destroying the structural integrity of an organ.”

IRE holds particular potential for treating liver, lung, and pancreatic cancers that are close to blood vessels and other sensitive structures — situations in which normal heat or cold ablation is not feasible.

Encouraging Study Results

After validating the safety of IRE in animal studies, Memorial Sloan Kettering’s interventional radiologists and surgeons have begun using the procedure in select patients who are not eligible for other treatments — particularly, patients with cancer that has spread to the liver from other sites in the body.

Early results suggest IRE can be effective and safe. In the January 2014 issue of the Journal of Vascular Interventional Radiology, Dr. Solomon’s team reports that IRE was used successfully in 11 patients to treat a total of 22 small tumors that had spread to the liver from other locations. In 15 treatment sessions, the tumors — which had a median size of 3 centimeters — were destroyed with no major complications. Many of the tumors were located less than 1 centimeter from bile ducts, making thermal ablation too risky.

Memorial Sloan Kettering specialists will continue to explore IRE in other types of cancer, although in every case it needs to be compared with thermal ablation and other minimally invasive treatments. Dr. Solomon’s team recently received a grant from the National Institutes of Health to investigate the use of IRE in lung cancer, which they hope to begin in 2014.

A strong feature of the Interventional Radiology Service has been the addition of a biomedical engineer, Govind Srimathveeravalli, who has worked with the clinical team to optimize the use of IRE.

“For complete tumor destruction with IRE, it is important to achieve a uniform electric field within the target region,” Dr. Srimathveeravalli says. “As tumors are heterogeneous in nature, treatment planning for IRE can be a challenge to physicians. I use physics simulations and work with Dr. Solomon to develop guidelines for optimizing treatment plans. We also perform research to develop new devices that will extend the reach of IRE therapy to new anatomical locations.”

“Our research program will be focusing a lot of energy on developing and refining IRE over the next few years,” Dr. Solomon adds. “There are still important questions that need to be answered — such as whether IRE actually destroys all the cancer cells — but we hope it becomes another tool that physicians can rely on when nothing else is suitable.” 

Comments

Can this be used on tumors in the brain

Mary,

This technology is still experimental and it is too early to say which types of cancer it will be effect in treating.

Thank you for your comment.

What is it about liver, lung, and pancreatic cancers that makes IRE hold a particular potential for treating?

Elizabeth,

IRE could be useful for these cancers because they are often located near blood vessels, nerves, and other sensitive structures that could be damaged by other treatments such as surgery or thermal ablation.

Thank you for your comment.

what about a primary tumor as opposed to a metastatic tumor?

Pat, thank you for your comment. We consulted with Dr. Solomon on your question and he responded:

Yes. Primary tumors have been treated as well. This is still an early time for the technology and there is still a lot to learn. Our efforts are primarily in cases where we have few other options.

Would this treatment work on small cell cancer

Keith, the technology is still experimental and it is too early to say which types of cancer it will be effective in treating. It is currently being used in cases where doctors have few other options.

Thank you for your comment.

I couldn't be more proud of my son, Gordon Single, product manager for AngioDynamics, for working with your team. This will revolutionize the treatment of cancer thanks to your fine work!

I was diagnosed with Stage IV Colon / Liver cancer in June of 2013. I've finished round 11 of chemotherapy and will soon reach number 12. At that point, my medical team will decide if I'm to receive liver directed chemo, radiation implants to the liver, or just continue on maintenance chemo program?

I'm very interested in the possibility of this procedure in the very near future if its available now for use?

I am insured, and am willing to do what ever is necessary for a second chance at life.

Jeff, thank you for your comment. If you would like to make an appointment with a Memorial Sloan-Kettering physician, please call our Physician Referral Service at 800-525-2225 and explain the details of your situation or go to http://www.mskcc.org/cancer-care/appointment.

Greetings. My mother is a 58 years old female. She has recurrent/rectal cancer at 1 cm from anal verge. She had TAE/TAMIS on 7/16/2013. Pathology 3 cm tumor, T2 (invades through muscular propria, + LVI, no LN seen) T2NXMX, distal margin + on September 2013, she had a colostomy for colonic obstruction. On January 31, 2014, she was subjected to a Laparascopic APR with Lymphadenectomy. Unfortunately, this wasn't concluded since apparent
metastasis (Pelvis) was present (No Vital organs at this point). She has been referred for Chemotherapy.

My question is. Is she a possible candidate for IRE? We are ready to travel since we are from Puerto Rico. Please let us know. We are so anxious with all this situation.

v/r

Dear Felix, we are sorry to hear about your mother's recurrence of rectal cancer. The technology is still experimental and it is currently being used in cases where doctors have few other options.

If you would like to make an appointment for your mother to have a consultation with one of our physicians, please call our Physician Referral Service at 800-525-2225.

Thank you for reaching out to us.

does the procedure work on lymph nodes?

Judy, thank you for your comment. We consulted with Dr. Solomon and he responded:

"We have done lymph nodes but it depends where they are and how they fit into the overall clinical picture."

Peri portal lymph node?

Judy, Dr. Solomon responds regarding use of IRE on peri portal lymph node:

It would depend on the case.

Great work! keeping the bad guys out of the human body is a challenging task. when that challenge is met effectively, lasting joy and contentment is what stays with a former patient who might have been hopeless prior to treatment. My current focus is the human heart. I am not an expert, but the materials that I consult gives me knowledge that I did not really acquire during my bio courses. Congrats! if you would allow me to. I hope the IRE technique proves to be effective for the targeted major organs.

My wife has a metastatic melanoma stage IV. There are multiple metastasis - however, the most dangerous are on liver and on spine that causes stenosis. She is on anti-PD1 trial. May IRE be helpful for her?

Dear Eugene, we are sorry to hear about your wife's diagnosis. We cannot answer personal medical questions on the blog, but in general, the technology is still experimental and it is too early to say which types of cancer it will be effective in treating. It is currently being used in cases where doctors have few other options.

If your wife would like to make an appointment for a consultation with one of our physicians, please call our Physician Referral Service at 800-525-2225.

Thank you for reaching out to us.

Can I.R.E. be performed on soft tissue mass around the spine? Thought to be Metastatic PC?

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