Hope for new therapy for inoperable tumors

Irreversible electroporation (IRE) This is an alternative to surgical treatment. treatment of tumors, especially used in the pancreas, liver, kidney or prostate. In some cases of inoperable tumors, treatment options are limited, especially when the tumors are located near delicate structures. IRE opens up therapeutic options that push the boundaries of what can be treated with tumor ablation, thereby increasing patient survival, according to Rodrigo Alonso-Gonzalez, interventional radiologist member of the Spanish Society of Medical Radiology (Seram) and the main author of the article mentioned in the treatment published in the journal Radiology: “Irreversible electroporation: expanding the boundaries of ablation.”

He pancreatic cancerwith its late diagnosis and aggressiveness, represents a type of cancer the deadliest in medicine. For patients with inoperable tumors, options are limited and the prognosis is dismal. IRE is emerging as a treatment alternative that may improve the survival of patients with locally advanced cancer without metastases. Alonso-Gonzalez notes that “in addition, in cases where tumors are borderline resectable, IRE can shrink them enough to allow surgery and removal with better results.”

For destroy the tumor, IRE uses electricityapplied using high voltage electrical impulses. To deliver these pulses, it is necessary to precisely position the needle electrodes around the tumor using Ultrasound and CT as a visual guide. “The needles used are similar in size to blood sampling needles and are inserted through the skin. The applied electrical current causes the creation of small pores in the membrane of the tumor cells, which ultimately leads to their death,” notes Alonso-Gonzalez.

Unlike the rest ablative methodsIRE manages to destroy the cancerous cell without damaging vital structures surrounding the tumor, such as blood vessels, urinary tract or bile ducts. This unique characteristic allows it to be used for tumors with difficult localization for other ablative methods and surgical operations, for example, for centrally located kidney tumors or liver tumors close to large vessels.

Besides, malignant cell after destruction of IRE, It releases molecules that allow us to activate our own immune system against the tumor. “There are even several cases described when this effect caused metastasis located at a distance from the tumor being treated (abscopal effect). This is all of great interest as more and more drugs are becoming available that activate our immune system against various types of cancer (immunotherapy) and its combination with IRE are very promising,” comments Alonso-Gonzalez.

The role of the interventional radiologist

Like others tumor treatment Using ablation, such as radiofrequency or microwave, IRE is a minimally invasive procedure: patients go home in 24 to 48 hours, without a scar and with a much faster recovery than surgery. As with other interventions, general anesthesia is also required and this procedure also requires special monitoring and management.

“IRE is a treatment with a great future. Many studies comparing IRE with conventional treatment will be published in the coming years, which will help us understand what role this therapy may play. combination of IRE with immunotherapyfor example, is getting really encouraging results in the first studies conducted. In addition, technological advances such as single-needle IRE or increasingly precise robotic and planning systems paint a truly promising picture,” explains Alonso-Gonzalez.

The interventional radiologist is the specialist who performs this procedure. Accurate placement of multiple needles around a tumor is challenging, and prior experience with tumor ablation treatments is required.