What Should Be the Alternative When Cancer Is Unresectable?

Introduction to the conference

With the purpose of further standardization and promotion of minimally-invasive ablation treatment for cancer, China Forum on Ablation Therapy in conjunction with the 3rd China Forum on Embolization Therapy was convened from August 4th to 7th, 2016, in Tianjin, together with the establishment of Ablation Expert Committee at the same time. Apart from well-known experts and scholars abroad, the conference also brought together specialists from varying medical fields including epidemiology, surgery, medicine, radiotherapy, medical imaging, pathology to address on new technologies and concepts. Prof. Niu Lizhi, president of Fuda Cancer Hospital affiliated to Jinan University School of Medicine, upon the invitation, delivered a keynote speech titled New Minimally-invasive Treatment of Pancreatic Cancer- Argon-Helium Cryosurgery and NanoKnife Therapy (irreversible electroporation).

Ablation therapy brings a new hope for cancer patient

It is statistically shown that nearly one-third of families in China might be threatened by cancer in the next decade. More seriously, 80% of cancer patients are already at advanced stage upon the first diagnosis, leaving them no opportunity of having surgical resection, for lacking in awareness of tumor prevention. In such a case, how to improve the survival rate and life quality of cancer patients has become an important issue in today's medical field.

Surgical resection, chemotherapy, radiotherapy are the three conventional treatments for cancer, which, however, are only effective in 20%-30% cancer patients. With the development of imaging technology, interventional oncology has already become one of four “pillars” in cancer treatment.

Prof. Niu Lizhi pointed out that interventional treatment, the fastest developing ablation treatment today, includes thermal ablation (Radiofrequency, microwave) and cold ablation (cryoablation and liquid nitrogen); irreversible electroporation (NanoKnife) is neither cold nor hot special technique; there are some technologies in development, such as laser, focused ultrasound etc.

Ablation therapy can not only bring hope for those middle-advanced cancer patients with urecsectable tumor, but can also achieve the same curative effect as surgery in treating some early-staged cancers, like liver cancer, kidney cancer and prostate cancer.

Different types of ablation technology are applicable to different tumors, for example, thermal ablation including RF, microwave are mainly used for treating liver cancer, while cryosurgical ablation are more suitable for prostate and kidney cancer; NanoKnife with the advantage of being neither hot or cold stands out as a preferential treatment for pancreatic cancer which is particularly intolerable to thermal ablation.

Local ablation has advantages in treating pancreatic cancer 

The modern cryosurgical ablation represented by argon-helium technology emerging in the last 20th century together with IRE (irreversible electroporation, namely, NanoKnife) that rapidly developed in recent years both brings a new hope of life to cancer patients with inoperable tumor.

Prof. Niu Lizhi highlighted the advantage of cryoablation and NanoKnife in treating pancreatic cancer in his speech. 

In recent years, pancreatic cancer morbidity dramatically rises in China and many other Asian countries and regions, along with the change in dietary structure (meat takes up increasingly higher proportion in resident's dietary) and living environment, etc.

Surgical resection, as the primary option in treating pancreatic cancer (regarded as the king of cancer), is however rarely applied in real terms for the late detection. And chemotherapy, as another optional treatment, is insensitive to pancreatic cancer in practical terms. In recent years, Fuda Cancer Hospital conducted a series of treatments including argon-helium cryotherapy, NanoKnife effectively treating numerous middle-advanced stage cancer patients, and basically achieved its aim at controlling tumor progression, improving life quality and prolonging survive time.

Prof. Niu Lizhi introduced that Fuda Cancer Hospital took the lead in developing Nanoknife therapy in Mainland China in July 2015, and it was also the first hospital to report preclinical study of Nano-knife ablation on pancreatic cancer, which proves that NanoKnife makes no destruction on bile duct, portal vein and other important intracorporal organs (see Journal of Interventional Radiology, 2015).

In addition, Fuda Cancer Hospital has already published seven papers on NanoKnife therapy for pancreatic cancer in US Pancreas-the world’s most authoritative journal in the field of pancreas.

Up to now, Fuda Cancer Hospital has performed NanoKnife ablation on over 140 cancer patients, and half of those patients are pancreatic cancer patient.

During the 5th International (Guangzhou) Forum for Cancer Treatment held on Jul. 2nd, 2016, two IRE procedures were live broadcast. The surgeon was Prof. Niu Lizhi. One of these two patients, a 55-year old Hong Kong SAR resident, had repeated fever and abdominal pain since early 2016. After inspected, he was found a tumor measuring about 3.8cm in pancreatic tail and diagnosed with pancreatic cancer. On the live broadcast, Prof. Niu performed IRE on the pancreatic tumor under the guidance of ultrasound and CT scan. The procedure went successfully and intraoperative bleeding was only 2ml, which greatly wowed all the guests present.

Prof. Niu Lizhi pointed out that Nanoknife has more advantages compared with other ablation technologies. For example, it is selective for tissue ablation, which damages cells rather than vascular walls, nerves, bile ducts, intestinal canal and so on. The ablation procedure can be displayed by ultrasound, CT or MR, ensuring that ablation effect was to the best therefore. Therefore, Nanoknife ablation, especially applicable to the tumor around great vessels, hepatic hilus, gallbladder, bile duct and ureter, shows unique advantages in treating pancreatic and liver cancer.

The New Technology Could Bring Benefits to Cancer Patients if the Tumor is Identified

Ms. Gurli, a 68-year-old Danish anti-cancer celebrity

“To know others having cancer is one thing, but to know yourself having cancer is another thing. My world was almost collapsed when I got to know my diagnosis.” Ms. Gurli, a retired Danish teacher said when she was sharing her experience of “living with cancer”. It~s hard to tell that she has been a 68-year-old cancer patient from her energetic demeanor. In 2008, her Danish doctor claimed that “she only had three to four months to live whatever treatments she would receive”. What it is that has made her such an active and humorous person 8 years later.

In the morning of March 16, 2016, Guangzhou Fuda Cancer Hospital held a special experience sharing meeting, on which the cancer patient Ms. Gurli, the 100th patient who has underwent NanoKnife illustrated to the attendants the success of NanoKnife with her own experience. It is known that conventional resection operation would inflict great physical trauma to cancer patient; it makes cancer patients even more painful to undergo radiotherapy and chemotherapy. Moreover, resection operation would often inflict irreversible damage to normal tissues, blood vessels and nerve system in particular. The physical trauma and damage would adversely affect postoperative recovery and the living quality of patient. Hence, in the face of treatment, cancer patients have more fears to the operative wound and the trauma that might be caused by resection operation. Fortunately, we are pleased to see the application of a latest treatment modality for cancer that is NanoKnife. According to Prof. Niu, Executive President of Guangzhou Fuda Cancer Hospital, during the procedure of NanoKnife, high electric-field and ultrashort pulses are given to destroy lipid bilayer structure of cancer cell membrane and form numerous irreversible nano-sized pores in the cell membrane. Cell membrane permeability will be changed to allow molecules of different sizes free access to cells, which will lead to cell death. Apoptotic tumor cells will be consumed by immune cells as their antigens are exposed. The zone where tumor was located will be replaced by normal cells and resume normal function gradually. In short, NanoKnife is a mini-invasive, harmless or low harm, precise and effective method for tumor inactivation. The most distinctive feature of NanoKnife is that it can preserve the normal tissues and structures in the targeted area in a non-invasive way so as to create favorable conditions for the blood vessels, nerve tissues in the ablated area to restore their normal function. Ms. Gurli underwent NanoKnife for the multiple neuroendocrine neoplasms in liver on March 8, 2016. She was full of spirit and energy and was able to walk and talk like a normal person when we met her at the experience sharing meeting. Such a fast postoperative recovery can never be seen in traditional resection operation.

Dr. Lu Mingying, the Rank Prize winner and Chinese scientist shared with the attendants her successful treatment experience

Another special patient also presented at the experience sharing meeting. She is Dr. Lu Mingying, the Rank Prize winner and Chinese scientist. She learned of NanoKnife on the internet. She noted, “I searched on the internet with NanoKnife as the keyword and found Guangzhou Fuda Cancer Hospital in the end. I made several phone calls to FUDA and learned that FUDA has completed over 70 cases of NanoKnife at that time. I believe that NanoKnife has been well developed at FUDA and I made the decision to FUDA to receive NanoKnife.” Prof. Niu said, “She could not walk due to intense abdominal pain and abdominal distension upon admission.” Dr. Lu Mingying underwent NanoKnife at FUDA on February 2, 2016. She had her symptoms alleviated significantly and was able to walk on February 6. It is reported that NanoKnife is applicable to liver cancer, lung cancer, kidney cancer, prostate cancer and other solid cancers. It has distinctive advantage in treating tumors that is close to hepatic hilus, gallbladder bile duct, pancreas, and ureter. Moreover, over half cases of NanoKnife in China are completed at Fuda Cancer Hospital.


Xu Kecheng, Chief President of Guangzhou Fuda Cancer Hospital noted that over the past ten years, Fuda Cancer Hospital has been committing to treat advanced cancer--a difficult medical problem in the world with “3C+P” treatment model dominated by cryosurgical ablation (CSA), cancer microvascular intervention (CMI) and combined immunotherapy for cancer (CIC) with an aim of prolonging patients~ life and improving their quality of life. FUDA has been leading the world in terms of the number of cases and types of cancer that CSA has treated; FUDA has also made breakthrough achievements in treating central lung cancer, great hepatic carcinoma, and pancreatic cancer with CSA, which has won several awards for FUDA at home and abroad. In June, 2015, FUDA introduced NanoKnife equipment from America and carried out the first NanoKnife on pancreatic cancer in mainland China on July 2, 2015. As of now, FUDA has completed 100 cases of NanoKnife, the number of which ranks the first in China.


On the same day, Guangzhou Fuda Cancer Hospital and BGI Group signed a strategic alliance agreement. FUDA-BGI strategic alliance allows experts on both sides to carry out concrete discussion on the cooperation vision and feasibility of the building and application of tumor sample data base, tumor detection at molecular level and the screening and early warning of high risk group by combining cancer high incidence scene and high-throughput sequencing.

FUDA Completed 100 Cases of NanoKnife (IRE), The Number of Which Ranks the First in Mainland China

In the morning of March 16, 2016, Guangzhou Fuda Cancer Hospital held a press conference, announcing that FUDA has completed 100 cases of NanoKnife, the number of which ranks the first in mainland China. Journalists from over ten media, including Xinhua News Agency, China News, Yangcheng Evening News, Nanfang Daily, Guangdong TV witnessed the moment. Two patients, Ms. Lu Mingying, winner of Rank Prize in England and Ms. Gregerson Gurli, a teacher from Denmark, who have gained benefits from Nanoknife  shared with the journalists their anti-cancer experience at the press conference.

Prof. Niu Lizhi, President of FUDA, announced that Guangzhou Fuda Cancer Hospital has completed 100 cases of NanoKnife

  

A memorable moment

At 1:30 p.m., March 8, 2016, Prof. Niu Lizhi, President of Guangzhou Fuda Cancer Hospital walked into the operation room in the dark green surgical gown to perform one case of NanoKnife.

It was a memorable moment as it marks the 100th case of NanoKnife that Guangzhou Fuda Cancer Hospital has done. The patient lying on the operating table was Ms. Gregerson Gurli, a 68-year-old retired teacher from Denmark--a legendary woman. In 2007, she was diagnosed with pancreatic cancer with liver metastases. Her doctor in Denmark said she only had two to three months to live. As she found no other good treatment in several European hospitals, she came to Guangzhou Fuda Cancer Hospital for treatment in February 2008. Gurli has undergone cryoablation, iodine seeds implantation therapy and other comprehensive treatments at FUDA from 2008 till now. Despite that cancers are still present in her body, she has survived for over 8 years since diagnosis. It is the concept of living with cancer that has rendered her a prolonged life. 

Prof. Niu noted that the 100th case of NanoKnife was done on liver tumors. “Recently, Ms. Gurli has been found to have multiple neuroendocrine tumors in liver. There are three tumors detected, the largest is about 5cm in size and the other two are about 4cm and 2cm in size respectively. Considering that the masses are big in size and are close to important structures as hepatic diaphragm dome and hepatic hilus, NanoKnife therapy will be able to deliver higher safety and less side effects. ”

All was ready and the treatment got started. The medical team led by Prof. Niu performed ablation on the biggest mass first. The mass was located at the S7 of liver and had high activity. Under the guidance of ultrasound and CT scan, Prof. Niu punctured the two NanoKnife probes into the base of tumor for ablation. Then the probes were relocated to ablate the other two masses. The screen clearly showed that the masses became necrosis and gasification after ablation; small bubbles were formed; the previous high-density echo became lower...

Prof. Niu was satisfied with the ablation result. He noted, “As NanoKnife is a highly secure and mini-invasive treatment, the multiple masses in liver can be ablated at one time. Today, three masses in her liver have been ablated. The procedure went smoothly.”

Five great leaps achieved by FUDA in the research on and clinical application of NanoKnife

At the press conference, Prof. Niu Lizhi introduced to the reporters that NanoKnife is currently the latest cutting-edge ablation technology for tumor in the world. During the procedure, high electric-field and ultra-short pulses are given to destroy lipid bilayer structure of cancer cell membrane and form numerous irreversible nano-sized pores in the cell membrane. Cell membrane permeability will be changed to allow molecules of different sizes free access to cells, which will lead to cell death. NanoKnife has been approved by America FDA in April, 2012 and has been certified to CE certification of EU. In June 2015, NanoKnife was approved by Chinese FDA for clinical application. Guangzhou Fuda Cancer Hospital has been five No. 1 in terms of the research on and clinical application of NanoKnife.

 1. FUDA is the first cancer hospital in mainland China to have introduced NanoKnife.

2. As early as in August 2014, Xu Kecheng and Niu Lizhi compiled and published New Technique of Cancer Ablation Irreversible Electroporation--the first monograph on NanoKnife in China.

3. On July 2, 2015, the first case of NanoKnife in mainland China was completed at FUDA. The patient was a 61-year-old pancreatic cancer patient from a Middle East country.

4. As of March 8, 2016, 100 cases of NanoKnife have been done for patients with advanced pancreatic cancer, liver cancer etc. It has ablated the lesions and improved the quality of life for cancer patients. The cases of NanoKnife that has been done at FUDA rank the first in mainland China.

5. The number of papers on NanoKnife published on authoritative magazines, including Journal of Interventional Radiology and Chinese Journal of Radiology, etc. ranks the first in China.

Prof. Niu Lizhi noted, “NanoKnife can achieve complete ablation on small tumors and control and shrink big tumors. Looking back on the 100 cases of NanoKnife we have done, we found that NanoKnife has been delivering good curative effect for pancreatic cancer and liver cancer patients. The remission rate exceeds 80%, approaching the world level. With the development of the technology and the accumulation of experience, I’m convinced that NanoKnife will bring benefits to more cancer patients.”