Dr. Niu Lizhi, the President of Guangzhou Fuda Cancer Hospital visited cancer survivors in Jakarta

On April 11, 2016, Dr. Niu Lizhi, the President of Guangzhou Fuda Cancer Hospital, visited previous cancer patients of Fuda Cancer Hospital in Jakarta after attending ASEAN (International) Forum on Intestine Cancer Treatment in Bali. Affra  Siowardjaja (born in May 6, 1956), who suffered from stage IV breast cancer with bone metastases, have survived 12 years without recurrence after receiving comprehensive treatments that include cryosurgery, chemotherapy and repair surgery, chemotherapy and immunotherapy at FUDA in 2004.

Breast cancer patient Mary Laurensia, born in August 6, 1969, was found to have a breast mass in 2007 but she did not pay any attention to it. In 2008, the mass was found to have grown bigger especially after the pathological examination, which confirmed that she suffered from Stage III breast cancer. She has survived 8 years without recurrence after receiving argon-helium cryosurgery, 6 cycles of chemotherapy, 35 sessions of radiotherapy and endocrine therapy for three years.

Prostate cancer patient Fachrutdin Tjoe, born on August 4, 1947, has survived 7 years without recurrence after receiving argon-helium cryosurgery, interventional chemotherapy in 2009. Oral and liver lymphoma Yana Sari Putri Sihombing, born on January 4, 1079, has survived 7 years without recurrence after receiving argon-helium cryosurgery and chemotherapy at FUDA in 2009. 

Anal canal carcinoma patient Tan Hong Som, born on December 4, 1950, has his anus successfully preserved after receiving PDT (photodynamic therapy), interventional chemotherapy and CIC (combined immunotherapy for cancer) at FUDA instead of going through colostomy in other hospital. Patient has survived 5 years without recurrence and enjoyed high-quality life with the anus in situ since the treatment. 

Pancreatic cancer patient Litasari Karwita, female, 55 years old, has been enjoying a stable condition since treatment three years ago. Kidney cancer patient Henry Widjaja, male, 52 years old, has successfully had his kidney preserved after undergoing argon-helium cryosurgery. 

Advanced uterus cancer patient Yang Chunmei, 80 years old, has survived almost 10 years after going through interventional chemotherapy, photodynamic therapy, argon-helium cryosurgery and immunotherapy at FUDA in 2007. 

Lung cancer patient Dr. Tjan Kian Seng, male, 83 years old, has survived 5 years after undergoing one single cycle of cryosurgery. Liver cancer patient Zhong Guoqing, male, 71 years old, has survived 6 years without recurrence after receiving argon-helium cryosurgery and interventional embolization in early 2010. Some of the above-mentioned patients were not be able to present at the lecture due to private affairs but all of them expressed their appreciation to Dr. Niu Lizhi for coming all the long way to visit them.

Dr. Niu Lizhi noted that cancer is still a world problem. Though new drugs and new technologies are emerging by each passing day, patients cannot make progress on their anti-cancer journey without their own persistence, the encouragement and support from the family members and the rational application of innovative treatments by the doctors. Fuda Cancer Hospital has adopted the latest technology for cancer –NanoKnife, which has proven to be effective in treating pancreatic cancer, liver cancer, etc. During the procedure, 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. Tumor cell death is induced while surrounding nerves, blood vessels, intestinal canals, bile duct remain intact. Doctors at FUDA hope to bring about more survival benefits for cancer patients with the latest technology. After met with previous patient, Dr. Niu provided free consultation for new diagnosed cancer patients who come all the long way to him.

                  From left: chief editor Li Zhuohui, breast cancer survivor Mary Laurensia, and Dr. Niu Lizhi

From left: liver cancer survivor Marison Pangadean Siagian, chief editor Li Zhuohui, prostate cancer survivor Fachrutdin Tjoe, Dr. Liu Zhengping

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 development of brachytherapy in China gained the world’s attention

By Dr. Niu Lizhi  executive president of Jinan University School of Medicine affiliated Fuda Cancer Hospital

June 28th, 2016, the second day of the 2016 ABS World Congress-American Brachytherapy Society, was the time for Chinese experts to demonstrate the development of brachytherapy in China. The congress has witnessed the speeches of over 10 Chinese medical experts and 20 wall posters. The original research in China has gained the word’s attention. In particular, the scientific literacy and Englishproficiency of Chinese doctors are inspiring. I firmly believe that the development of brachytherapy for cancer holds a bright future in China.

                   CIBS members and chairman of the congress

On the same day, Prof. Zhang Fujun, Prof. Wang Junjie and Prof. Zhang Jianguo from Interventional Brachytherapy Branch, Committee of Minimally Invasive Therapy in Oncology, Chinese Anti-cancer Association established official relations with ABS, which has for the first time secured China’s Brachytherapy Society’s place in the world arena. It is fair to say that the day is a milestone in the history of brachytherapy in China.

Expert meetings

ABS World Congress-American Brachytherapy Society and CIBS held their first official meeting in San Francisco on June 28th, 2016. Prof. David Gaffney, incumbent chairman of ABS/WCB, Prof. Steven Frank, former chairman of ABS/WBC, Secretary Ms. Cate Yashar, CFO Firas Mourtada, the executive director Mr. Rick Guggolz met the incumbent chairman Prof. Zhang Fujun, former chairman Prof. Wang Junjie, vice-chairman Prof. Zhang Jianguo, after-loading therapy expert Prof. Cheng Guanghui of Interventional Brachytherapy Branch, Committee of Minimally Invasive Therapy in Oncology, Chinese Anti-cancer Association and discussed matters, including cooperation, exchange visits, young doctor training, etc.

Prof. Wang Junjie delivered a speech titled “China Brachytherapy Update-Current Situation & Prospectives”, introducing to the audience the status quo of Brachytherapy in China, 3D Printing Individual Templates Guided Brachytherapy and technology promotion. Prof. Zhang Fujun briefed to the participants the achievements made in the field of brachytherapy in China in the past ten years and more, especially the innovations made in radioactive particle stent and 3D printing.

Experts from other countries spoke highly of the innovation spirit of Chinese doctors shown in developing radioactive particle stent, 3D printing and rapid degradation particle chain and have tentatively reached an accord that a special session on seed implantation therapy will be set up for Chinese experts at the next session of forum to be held in Boston in April 2017. Moreover, several leaderships and experts from foreign Societies will be invited to attend China Academic Conference on Seed Implantation for Cancer or China Congress of Brachytherapy for enhanced communication and understanding to make World Congress of Brachytherapy to be held in China.

Congress summery

June 28th, 2016 was the day for Chinese experts to demonstrate the development of brachytherapy in China. At the congress, 10 delegates from Chinese delegation delivered speeches and 20 wall posters were put up, which have gained the word’s attention. In particular, the scientific literacy and Englishproficiency of Chinese doctors are quite inspiring.

Prof. Niu Lizhi, Jinan University School of Medicine affiliated Fuda Cancer Hospital delivered a speech and had his paper posted

At the congress, several Chinese experts showed to the participants the research on radioactive seeds for solid tumors. Prof. Wang Juan from Hebei General Hospital reported the research on radioactive seeds implantation therapy for retroperitoneal tumor. Prof. Li Yuliang from the Second Hospital of Shandong University reported the research on seed implantation therapy for pancreatic cancer. Prof. Niu Lizhi from Jinan University School of Medicine affiliated Fuda Cancer Hospital reported radioactive seeds implantation therapy for cardiac tumor and pancreatic tumor. In addition, the reports delivered by experts from Tianjin Medical University, Jiangsu Province Hospital, Chinese PLA General Hospital have gained extensive attention from the participants.

In recent years, China has made significant development in the field of radioactive seeds implantation therapy for cancer. The innovative research and superb achievement made by Chinese experts can be shown in the following aspects:

1、Seed chain

An US study shows that when it comes to seed implantation in the prostate cancer, the rate of seed displacement to lung by using particle chain is much lower than that of chainless seed implantation. Moreover, using particle chain has guaranteed the uniform distribution of the seeds and the dosage also, which is the main reason why doctors from the US give preference to particle chain. The degradation of particle chain needs 90 days. In comparison, the degradation of particle chain material, a patent owned by Prof. Zhang Fujun from China only takes 10 days. Medical experts showed great interest in the new material, hoping that Prof. Zhang Fujun could commercialize it in the shortest term.

2、MR

The focus of the current session of conference is that many hospitals in the US have been performing brachytherapy under MR guidance especially for pelvic organ tumors in that MR is the most accurate imaging examination for pelvic organs, such as prostate, uterine neck, rectum and anus. Brachytherapy for tumors in these organs requires precise positioning. MR-guided brachytherapy has just started in China. Prof. Li Chengli from Shandong Medical Imaging Research Institute is an authoritative expert in MR-guided brachytherapy. We believe with his effort, MR-guided brachytherapy will be more and more widely used in China.

3、Brain tumor

An American hospital carried out a research where radioactive seeds are inserted into the surrounding tissue after primary brain tumor resection in order to prevent tumor recurrence. The research showed that radioactive seed implantation in the surrounding tissue after primary tumor resection can reduce the recurrence rate of tumor. Prof. Hu Xiaokun, chairman of Image Technology Branch, Committee of Minimally Invasive Therapy in Oncology, Chinese Anti-Cancer Association, has made remarkable achievement in the field of seeds implantation for brain tumor. Regrettably, he didn’t make it to attend the current session of congress. We hope he could attend the next session of congress to show to the world his research achievement.

Indian experts carried out research on radioactive seeds for head and neck tumor

4、Head and neck tumor

Head and neck tumor are the tumors of the highest incidence rate in India. The application of high dose rate Iridium-192 has achieved good curative effect as it is shown in the pictures below. The team of professors represented by Prof. Zhang Jianguo has made the most brilliant achievement in the field of brachytherapy for head and neck tumor. The clinical result and research achievement in brachytherapy for neck and head tumor are leading the world and have gained the attention of the participating experts.

      Indian experts carried out research on radioactive seeds for head and neck tumor

5、Vertebral tumor

Vertebrae are the most common site of metastases. Applying radioactive I-125 seeds implantation on metastatic vertebral tumor after failure of radiotherapy or when radiotherapy is not applicable is the innovation made by Chinese medical experts. Both team of professors represented by Prof. Wang Junjie from Peking University Third Hospital and team of professors represented by Prof. Huang Xuequan shared with the participants their experience and research on radioactive seeds for vertebral tumors, the good therapeutic effect of which has gained the attention of foreign experts.

6、Lung cancer

At the current session of forum, the only research report on brachytherapy for lung cancer was made by the team of professors represented by Prof. Zhang Fujun from Sun Yat-sen University. They reported the significant efficacy of radioactive I-125 seeds implantation for metastatic lung cancer and primary and unresectable lung tumors as well as the significant increase of local control rate and prolongation of survival time. The study was published in Radiology-the top magazine in interventional treatment. 

7、Radioactive seeds stent

The team of professors represented by Prof. Guo Jinhe from Southeast University reported the research results of animal experiment and clinical studies on radioactive seeds stent for tracheal-caused stenosis. The strategy has not only solved the problem of tracheal stenosis but also enabled the radioactive seeds to treat cancer, which has prevented tumor recurrence and effectively prolonged the survival time of cancer patients. The study was published in the well-known magazine Lancet Oncology.

Low-dose-rate seed VS high-dose-rate seed: each has its own strength

In the US, high-dose-rate seeds (including Palladium-103, Iridium-192) are used to treat solid tumors, prostate cancer excluded. High-dose-rate seeds can be taken away within a short period of time after radiating the tumor tissue, which can be classified into temporary seed implantation. In comparison, low-dose-rate seeds have to be implanted in the tumor for a long term, which falls into the category of permanent seed implantation. The advantages of temporary seed implantation are short irradiation time and good short-term effect though it also has its downside. Prof. Wang Juan from Hebei General Hospital noted that the protection of high-dose-rate seed is more difficult than that of the low-dose-rate one, which better suits Chinese condition. The advantage of low-dose-rate is that the total irradiation dosage can be increased. According to research from Japan, good tolerance is noted when prostate cancer patients were given I-125 seeds implantation, the radioactivity of which is up to 200GY. It also shows the safety of low-dose-rate seed implantation.

In a nutshell, both low-dose-rate seed and high-dose-rate seed have their own strength and are suitable for different tumors. We hope that seeds with different dose rates will be available for cancer patients in China.

Dr. Xu said cancer is not only to be killed but also need to be friendly treat.

Xu Kecheng, a doctor and professor in Guangzhou Fuda Cancer Hospital in China,and also a liver cancer survivor, who living with cancer about 11 years untill now, here i talk about him because he is the one kind doctor and worth people to know him.

Now, he is 76 years old,when his mother died from cancer, and after that for a few years, he found he also got a stage 3 liver cancer, someone suggested him accepted the traditional cancer treatment radiation, but he refused and accepted a long-term immunotherapy. The time and result showed that his decision is right, two of his cancer patients who are his friend also have the same cancer, but they accepted the hepatectomy, chemo and radio, finally, they died from the lower immunity function to fight the cancer,they just survived half a year after accepting the surgery.  

Why he is a good doctors? He have been doing the Clinical work over 50 years,he donated all his life to research and found the new cancer treatments,as a cancer patient too he know how painful and negative caused from cancer, so even in a old age he still decided to built a cancer hospital study new cancer treatments to save the cancer patients. He help many patients who from poor family, he always pay seriously attention to patients’ disease and health, how the patient feeling, what kind of pain they are suffering, he always try his best to help patients to go through the hard time before treatments, he said he love to visit the patients at any time, they just like his families like his precious persons.

Let Cancer Patients Survival Is The Absolute Principle

Dr.Xu said：“As a doctor i hope can provide patients the best suitable and “intelligent”treatments,

as a cancer patient and survivor, i hope all our doctors can provide the most right and least pain treatment to patients , as a soldier to challenge and fight cancer, i feel glory. I believe, human will finally to overcome cancer, our cancer patients will recovered or live with cancer in a long time.”

I remember Dr.Xu also mentioned that, cancer is our enemy which not just need to be killed but also need to be friendly treat, because enemies are too many to be killed and destroyed , or they will be opposite of the wish, just like the war, it is impossible to destroy all of enemies but let them completely convinced, they will never invade and attack us. The same ways to the cancer, if we could not kill all of the cancer cells, why not let us live peacefully with the survival cancer. With the years of experience in treating cancer, he got a new idea that they could combined different treatments depend on the patients’ body condition, so the main new treatment “3C+P” is on the use, this new research result have been recognized at home and abroad, the data shows there are 70% of cancer patients’ condition have obvious improvement, they prolong patients’ survival time and improve the quality of their life. The “ 3C+P” treatment main treat the cancer like unresectable, metastases on operation, no response on chemo/radio and recurrent advanced cancer.

Giving patients emotional concern and spiritual encouragement are every doctor’s duty.

Dr.Xu spend over 50 years in research cancer, have innumerable experience in cancer treatment and diagnose diseases, also great achievements and works, he is not only just a doctor, but also author, chief editor, he writing books and papers with number of words over ten million, who has or had a lot of academic titles, but he said let cancer patients survival are the glory and proud of thing for him. Every patients from home and abroad he will always spend over half hour to ask the patients’ body condition, that is vary important to hear clearly patients’ disease situation, feeling and demand, no matter when he will always spend some time to see the patients even in his busy days, he said the encouragement and confidence for patients before/after surgery are good to patients’ emotion and spirit to fight the cancer so that will also benefit doctors to do the surgery. As a doctor, should regard the patients’ life to be No.1 forever that also become a duty for every doctor, random to give patients to do chemo and radio are forbidden, the treatment plan must be discussed by professional and rich cancer-treatment experienced export and doctor to finish with his team, not just only serious requirement of doctors but also the nurse and every worker in fuda hospital.

The Main attending cases from Dr.Xu

Kidney cancer and bone metastases, pancreatic endocrine tumor, pancreatic cancer, retroperitoneal liposarcoma, “ dough figurine” retroperitoneal liposarcoma, non-small-cell lung cancer (NSCLC),  melanoma, esophagus cancer, multiple neuroendocrine tumor, breast cancer, ovarian cancer, neck giant teratoma,  uterine Cancer,  lymphoma, liver cancer and etc.

International social position

1. Chief president of Fuda Cancer Hospital, Jinan University School of Medicine

2. President of International Society of Cryosurgery (ISC)

3. Honorary president of Asian Society of Cryosurgery.

4. Special Adviser of Japan Society of Low Temperature Medicine

International Honors and Awards

1. China Provincial and Municipal Academic Awards for Enzyme and Isoenzyme Diagnosis for Hepatocellular Carcinoma.

2. Guangdong Provincial Academic Award for Cryoablation of Liver Cancer(2013).

3. Japan: JSLTM Gold Medal for Cryoablation of Pancreatic Cancer (2008).

4. Austra: Great Gold Medal for Cancer Cryosurgery(2011)

5. Austra: Excellent Work Award for Book Modern Cryosurgery for Cancer

publications

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.

Xu Kecheng’s Ward Round Essays: Four Cases of Pancreatic Cancer

On 26th February, 2016, it’s Friday. I made rounds of the wards and visited 14 patients including four pancreatic cancer patients which made me impressed.

The first case is a female of 58 years old with pancreatic tail ductal adenocarcinoma. She was admitted to FUDA for the first time on November last year. At that time, she suffered from severe pain on lower back. The CA 19-9 in the blood was 8000u/ml. The size of the tumor was 3*4 cm with peripancreatic lymph nodes metastasis. After having ultrasound screen and irreversible electroporation (nanoknife therapy) ablation guided by CT, the pain was relieved. Patient went back to hospital for re-examination this time, and the general condition was good. The patient complained of ambiguous pain on left abdomen, which was relieved by taking non-steriodal pain-killing drugs. And the CA19-9 dropped to 600u/ml. Then, the patient was having peripancreatic lymph nodes absolute alcohol injection guided by ultrasound screen. She was also having NK immunotherapy at the same time.  

The second case is a male of 65 years old. His waist has been painful for a month. Neck of pancreas occupying lesion is 3-5 cm with peripancreatic lymph nodes swelling. The biopsy showed adenocarcinoma. In January this year, under the guidance combined with ultrasound and CT scan, the lump of tail of pancreas and peripancreatic lymph nodes were ablated by percutaneous nanoknife (irreversible electroporation ) surgery. After surgery, abdominal pain was relieved quickly. He went back to FUDA for re-examination a week ago with mild pain on his abdomen. The MR re-examination showed that activity of original lump in the pancreas was cut by 90%. Under the guidance of ultrasound scan, he had local alcohol injection and NK cells injection for taking immunotherapy.

The third case is a male of 61 years old who comes from Hong Kong. The lump in the head of pancreas was 3cm, which suppressed common bile duct and caused obstructive jaundice. Serum bilirubin concentration was 65mmol/L. The tumor was ablated by nanoknife (irreversible electroporation) with the guidance of ultrasound and CT. After surgery, patient could walk and get ready to come back Hong Kong for having endoscopic common bile duct cathetering.  

The fourth case is female of 62 years old. She accepted surgery at a hospital of a big city which included resection of stomach, duodenum, common bile duct and the head of pancreas. And he had chemotherapy. On 15th February, 2016, he was admitted to our hospital. The CT examination showed that there were multiple metastases in liver and enlarged lymph nodes in the head and neck of pancreas. HepaSpherin microspheres intervention was injected percutaneously to hepatic artery. Recently he had percutaneous cryosurgical ablation on liver with the guidance of CT. At the same time, metastatic lymph nodes were injected with 125 iodine seeds. And he was ready to get NK cell immunotherapy. 

Recent years, the morbidity of pancreatic cancer has been increased obviously, which is the No.4 most common cancer of digestive system. Treating pancreatic cancer is still world’s challenge so far. As for the above four cases, the first three cases were accepting nanoknife (irreversible electroporation) therapy. When three cases were diagnosed as pancreatic cancer, there were metastases in peripancreatic lymph nodes and suppression in blood vessels, which was impossible to remove by surgery. As for unresectable pancreatic cancer, ablation plays an important role as alternative treatment nowadays. Cryosurgery and nanoknife are common ways to ablate tumors. In 2012, after nanoknife (irreversible electroporation) being allowed to apply in treating soft-tissue tumors in America, nanoknife for pancreatic cancer treatment attracts attention all around the world. It can ablate tumors in targeted area clearly without much harm to great vessels and intestinal wall. Nanoknife conducts nanoscale perforation to cells membrane by high voltage and short current pulse. It’s neither hot nor cold, which doesn’t cause obvious inflammation. As we know, inflammation is the main factor causing cancer’s development and metastases. Therefore, nanoknife makes fewer side effects on patients. Patients will recover sooner after surgery. 

According to the reports from ten great hospitals’ reports, nanoknife therapy for pancreatic cancer treatment has been applied in more than 3000 cases, and the therapeutic effects are good. Guangzhou Fuda Cancer Hospital has applied nanoknife therapy since last July, which was the first case of nanoknife application in the mainland of China. More than 50 cases of pancreatic cancer patients accepted nanoknife therapy. Initial follow-up shows that the ablation technique has a good therapeutic effect with slight complications.

The first three cases above accepted nanoknife therapy, which was correct. Of course, the long-term effects need to be further observed. The recent condition was steady and the pain was relieved obviously. The fourth case of pancreatic cancer patient accepted surgery at out-of-town hospital. It’s conventional treatment. Unfortunately, the lesion recurred with liver metastases. Why did it metastasize so quickly? Was it undiscovered before surgery, or was surgery promoting metastases?

In 2007, a report named “Reveal the Mystery about Treating Cancer Causing More Metastases” from America said, treating cancer by surgery, chemotherapy and radiation would probably lead to cancer cells metastases. Surgery can accelerate cancer. I don’t have direct evidence on this topic. Someone has compared the cancer metastases after cryosurgery and surgery in experimental animal mode. He found that cancer metastasis after having surgery was earlier and more severe. And he thought TGF-βincreased after surgery. It’s the factor that leaded to cancer cell proliferation. Cryosurgery and nanoknife therapy are local ablations. The damage of tissue is less, and died cancer cells after ablation release antigen, which stimulates immune cells to generate anti-cancer immunity. Then it reduce the incidence rate of cancer metastasis.   

It doesn’t deny surgery certainly. Surgery is still the main means of treating early-stage cancer with mastering indication. It’s hard to say whether the 4th case has surgical indication. The diagnosis of pancreatic cancer is often with metastases. Therefore, it should be especially cautious of evaluating patient’s condition and grasping surgical indication.

The February 26th ward-round was to solve the problem about subsequent treatment. The first three cases all accepted nanoknife therapy. It’s impossible to ablate all tumors. I am not advocating chemotherapy for its function of prolonging patient’s life is limited, especially to pancreatic cancer patient of middle and advanced stage.

Famous book Sun Tzu’s The Art of War once said that a cornered animal is a dangerous foe, which is full of philosophy. In other words, it means that not hotly pursuing an enemy who is caught in a hopeless situation. Fierce attacks make enemy to resist strongly, which leads to great cost inevitably. The right way is inducing it to capitulate and making it safe. Then, live peace with each other.

A great number of evidence shows that chemotherapy has opposite effect which not only kills no cancer cells, but makes cancer cells growing. No.4 case had chemotherapy after surgery. I can’t claim whether the opposite effect of chemotherapy promotes metastases.

I suggest the former patients taking immunotherapy mainly. At present, CIK-DC and NK cell immunotherapy are most practical among all immunotherapy adopted in our hospital.

Recently, I read a report of World J Gastrointest Pharmacol Ther.2016. It said that scholars from five units reported their result of applying DC cell-based vaccine in treating pancreatic cancer. They processed DC cell with streptococcus immunoadjuvent OK432 and made Vaccel vaccine. They found DC vaccine could promote Th1 at a favorable situation and generate IL-12 in the way they processed DC vaccine, which had a better effect on fighting against cancer. 255 inoperable pancreatic cancer patients injected the vaccine. It’s discovered that patients with positive DTH had longer survival time than patients with negative DTH. Then, the author added HLAI restrictive WT1-II and restrictive WT1-I into DC cell, which was proved to prolong survival time of pancreatic cancer patient. In Japan, OK432 is most common potentiator for boosting immunity in cancer treatment. There are medicines like OK432 at home. Such as highly agglutinative staphylococcin (HASL), it’s extracted from staphylococcin. It should be sublingual medicine for lots of sublingual lymph nodes absorbing and stimulating immunity directly. I suggest giving patient this medicine.

There is always one thing conquering another in nature. Snake is the enemy of rat; bat is the enemy of mosquito; and bird is the enemy of grasshopper. The same as in human body, to fight against cancer cells, we also can use the natural enemy of cancer cell. That is NK cell.

I read lots of literature, which demonstrated that in-vitro amplificatory and highly activated NK cell shows strong activity of fighting against cancer in vitro and vivo. Another clinical test shows that allograft NK cell is effective in treating lymphoma and progressive, recurrent and solid tumors. The author injected continually NK cell to the patients three times, and the highest number of NK cell was 3*107 (about 30 billion) per kilogram. Among 17 evaluable patients, eight patients’ condition (47.1%) tended to be steady. CD8+T cells which have killing effect on cancer cells increased and T cells correlated cytokines was up regulated. On the contrary, T cells, myeloid-derived suppressor cells and TGF-β(transforming growth factor-β) which have regulatory rather than inhibitory effect on cancer diseased. The author thought a great number of allograft NK cell injections not only were safe and available but also were important method to maintain organism’s effective immune response (Cancer Immunol Res.2016).
　　
Therefore, as to the four cases of pancreatic cancer above, I suggest giving cells adoptive immunotherapy. At meanwhile, I suggest adopting traditional Chinese medicine to adjust intestine and stomach, which also helps improve immunity. A few days ago, I offered eight kinds of TCM including salvia miltiorrhizae, astragalus, dried wolfberry, dried hawthorn, dried tangerine and Mangnolia officinalis etc. to the four patients above. After taking these TCM, distending pain of upper abdomen was relieved and the eating was improved.