Nanoknife - what are the qualification criteria?

[Marieb]

Hi all,

Early on in my diagnosis I did a little reading up on Nanoknife but must admit to being a little clueless. Can anyone tell me what is the clinical qualification criteria for getting it? I think I read somewhere that the tumour had to be kept within the Pancreas and not spread to the arteries ie not Locally Advanced as mine is. If anyone can point me towards the right information I would be very grateful.

Marie X

[RLF]

Hi Marie, I believe when it comes to pancreas tumours it can be near to the blood vessels or even attached as it doesn't use heat. Sometimes it's used to shrink the tumours and then surgically remove them. I don't know the success rates though. Hope that helps!

[PCUK Nurse Rachel C]

Dear Marie,

Apologies for not replying to your post sooner, however, I hope the below information is of some use?

Nanoknife or Irreversible electroporation (IRE) is an ‘interventional radiological procedure’ that is done under CT guidance and general anaesthetic. It usually requires an overnight stay in hospital.

Irreversible electroporation (IRE) is sometimes known as NanoKnife®, which is the brand name for one machine used to deliver the treatment.

The aim of the procedure is to destroy the tumour cell by destabilising the cell membrane, and this is done by subjecting it to high voltage/ low energy electrical pulses (< 2 mins) and this is using 3000 volt electrical current.

Very small needles are inserted through the abdominal wall once the tumour has been located by CT guidance. Then the electrical impulse is given in attempt to destroy the cell. As it is electrical current that it is used (it does not use thermal energy ie heat/cold) it does not harm surrounding structures or damage to vessels/structures nearby. As an ‘electrical current’ is used for this procedure, this is synchronised to the patient’s heart beat so that it does not cause a disruption to the patient as a normal ‘electric shock’ may do. It is important for the patient to be on a chemotherapy regime both pre and post procedure.

At this current moment in time, it’s important to remember that there has not been much research into IRE/nanoknife for people with pancreatic cancer. There have only been a few small studies, which unfortunately means that we don’t know enough about how effective it is, and who it is most suitable for. The criteria may also vary slightly from hospital to hospital.

From our understanding IRE/nanoknofe may be suitable for some people with locally advanced inoperable pancreatic cancer (cancer that can’t be removed by surgery and has spread to nearby structures such as blood vessels around the pancreas). There may be, however, slight differences in criteria, depending on which hospital you are being treated at.

Whether IRE/nanoknife is suitable for you, may depend on your own clinical situation. For example, it may depend on how big your tumour is or what other treatments you’ve already had (eg previous chemotherapy or radiotherapy). Currently it is our understating that IRE/nanoknife is only suitable for tumour’s less than 4cm long.

If you have a pacemaker or a history of recent heart disease, unfortunately you won’t be able to have IRE/nanoknife. This is because it involves using a high volt electrical current. During the procedure, every patient has their heart monitored so that the electrical pulses are delivered between heartbeats. This is when the heart is least affected by the electrical current.

We are currently aware that there are 4 NHS hospitals in the UK that are in the process of using IRE/Nanoknife treatment for patients with pancreatic cancer. These are Newcastle, Leeds, Birmingham and Kings in London (although it has been mentioned that Kings are no longer offering IRE/nanoknife- please see thier website for up to date information).

Marie, this information is quite generic, however, if you wish to phone our freephone support line (0808 801 0707), myself or one of the other specialist nurses would be more than happy to discuss this further with you.

Best Wishes,

Rachel

Pancreatic Cancer UK Specialist Nurse.

Support and Information Team.

[LMD]

Hi Marie

My Dad was booked in for Nanoknife... The tumour was in the head of the Pancreas, around an artery and there was no spread - he also had a metal stent. (Mentioning the stent as I remember wondering whether he would be able to have the procedure due to the stent but it was fine)

Hope things are going well for you xxx

[Marieb]

Thanks everyone, that really does help, I will give the support line a call in the next few days to discuss further. My tumor was 9cm and at my last CT Scan on Friday 25th Sept, after 4 cycles of Folfirinox it has reduced to 8cm. It's in the tail of my pancreas, the surrounding blood vessels and adrenal glands so I know I am Stage 4 Locally Advanced and it's bloomin' big.

My Oncologist has said to continue with the Chemo and we can discuss other treatments such as Nanoknofe later but I want to be fully informed about it so I can push for it if need be.

I am also p,anoint to call Heildleberg in Germany to see if they can offer anything our NHS can't. I am very lucky to have a brother who will help with costs which makes this an option that others may not be lucky enough to consider but I want to explore all possibilities.

Marie X