nanoknife IRE for pancreatic cancer

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RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Wed Aug 09, 2017 10:22 PM

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Pancreatic Neuroendocrine Tumors (Pancreatic NETs)

Dear Gloriab & Everyone:
          We haven talked for awhile about Pancreatic NETs.  So, this is a good opportunity.
          In a sense you are fortunate.  This rare form of pancreatic cancer is less deadly than Pancreatic Adenocarcinoma.
          Your first step is to STUDY the NCCN guidelines on NETs (NeuroEndocrine Tumors), downloadable here. 
http://jaxelection.altervista.org/pancreatic/NCCN3.2017Neuro
          Began at the middle of the document reading the TEXT describing the condition and therapy.  Then, the Staging system.  Then, the Evidence Blocks, focusing on the Efficacy column on the left.  Then, the decision tree at the beginning of the document.
          IRE is often performed intraoperatively as part of surgical resection (of which Whipple is a form), to manage tumor-encased blood vessels and to improve surgical margins.  And, IRE is used in some cases instead of surgery.
          Regarding your IRE vs Surgery question, we don’t know how much of the surgeon’s recommendation is based on his lack of IRE skills.  Even surgical resectability depends on the skill of the surgeon.  IRE is new territory in Canada.
          IRE should be performed by a surgeon who knows what he is doing.  Your Canadian trial was induced by mayor Hector Macmillan’s advocacy.  It may be more of a training exercise for surgeons.  Here are some training guides, in the event you go elsewhere:
http://jaxelection.altervista.org/pancreatic/Chap65Pancreati
http://jaxelection.altervista.org/pancreatic/3_IRE2013Learni
http://jaxelection.altervista.org/pancreatic/6_Martin2015IRE
http://jaxelection.altervista.org/pancreatic/IRE2016Update_M
http://jaxelection.altervista.org/pancreatic/CTFindingsPostI
          Get a surgeon who does pancreatic surgery at least biweekly.  And, prepare for surgery in the following ways:
http://jaxelection.altervista.org/pancreatic/16_ProtectYours
http://jaxelection.altervista.org/pancreatic/ImmunoNutrition
http://jaxelection.altervista.org/pancreatic/ImmunoNutrition
          What you do after surgery will be vitally important.  Rely on the NCCN guidelines and your PubMed and Google searches for the most effective adjuvant and maintenance therapies.  Read the following surgery and adjuvant therapy articles:
http://jaxelection.altervista.org/pancreatic/PancreaticNETsS
http://jaxelection.altervista.org/pancreatic/PancreaticNETsS
http://jaxelection.altervista.org/pancreatic/PancreaticNETsS
http://jaxelection.altervista.org/pancreatic/PancreaticNETsM
http://jaxelection.altervista.org/pancreatic/PancreaticNETsS
          Study these documents, and you will know.  Otherwise, you will be bewildered and make mistakes.  NET victim Steve Jobs, if he had made smarter choices, might be alive today.
          PhilipJax
PS: If a link appears dead, right-click and copy it. Then paste into a new browser tab. If extraneous symbols appear after the .pdf, remove them and press enter.

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Wed Aug 09, 2017 10:25 PM

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Gloriab & Everyone,
          My message on Pancreatic Neuroendocrine Tumors (Pancreatic NETs) is being reviewed by CancerCompass, because it has many links.  It may appear tomorrow.
         PhilipJax

RE: nanoknife IRE for pancreatic cancer

by tallysis on Thu Aug 10, 2017 12:35 AM

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Maybe someday, but even Dr. Martin did a Whipple on a friend when they found after opening her up that it was possible. When he does the IRE, its mimics a Whipple in many ways with the removal of the gall bladder and part of the stomach and intestine as well as the pancreas.

RE: nanoknife IRE for pancreatic cancer

by cdaley2 on Thu Aug 10, 2017 01:10 PM

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whipple or distal (if tumor is in the tail) is what everyone hopes for. It's being done more and more on people that 5 years ago would not have been "eligible". Everything you read on neo-adjuvant chemo/radiation is about reducing the size of a tumor or detaching it from an artery so that they can have the surgery. A tough operation to be sure (the distal, not so much) but at a major center that does many a year, it's relatively safe (inasmuch as surgery generally is relatively safe). I had a distal 11 months ago, with clean margins, 0 lymph nodes, and unfortunately lung mets were discovered a couple of months ago that were probably not visible at the time of surgery. Still, I think I am better off for having had it if only to have very little cancer burden in my body, if that makes sense. 

RE: nanoknife IRE for pancreatic cancer

by gloriab on Thu Aug 10, 2017 02:11 PM

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Thank you so much for your reply, your time and consideration is really appreciated! I'm glad to hear that the surgery went well for you and I wish you luck with your ongoing health concerns!

RE: nanoknife IRE for pancreatic cancer

by gloriab on Thu Aug 10, 2017 02:16 PM

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Thank you for your reply and clarification.  We are trying to do our due dilligence and were hopeful that we found a less invasive option.  We are certainly getting peace of mind with the research we are doing and the kind people sharing their experiences.

RE: nanoknife IRE for pancreatic cancer

by dessmo on Sat Aug 19, 2017 09:36 PM

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PhillipJax,

I was diagnosed with PC/Acinar Cell Carcinoma w/mets to the liver 8 months ago. Did 9 cycles of FOLFIRINOX with very good effect, so the surgeons agreed to remove the tumor from the tail of the pancreas 8 weeks ago. So no the tumor is gone, but I still have a total of 8 mets at my liver. They have been reduced in size during chemo, and the largest one is less than 20mm. My local hospital don’t recommend RFA/surgery, and nanoknife is not available here in Norway. What do you think, could nanoknife be an option? And do you have any recommendations for a clinic preferable here in Europe? I am male, 52 and with very good general health. I will meet with my oncologist next week to discuss treatment strategy, and are trying to find out what options there might be outside Norway.

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Sun Aug 20, 2017 01:54 PM

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Dessmo,
I expect to post a reply today. However, because it will contain many links, the forum system may delay its actual appearance by one day. PhilipJax

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Sun Aug 20, 2017 02:43 PM

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Acinar Cell Carcinoma of the Pancreas (ACC)
A
rare malignant exocrine tumor of the pancreas

Dear Dessmo & Everyone:
          I will get to liver metastases below.  But, first some background for those unfamiliar with Acinar Cell Carcinoma of the Pancreas (ACC)
1. ACC is a very rare form of Pancreatic Cancer.  It is slightly less deadly than Pancreatic Adenocarcinoma, the principal topic of this forum, but rigorous therapy is still required.
          Although it is not the same as Pancreatic Adenocarcinoma, in many cases ACC responds to adenocarcinoma and colon cancer therapies.
          The following two articles offer background:
http://jaxelection.altervista.org/pancreatic/AcinarLitReview
http://jaxelection.altervista.org/pancreatic/AcinarReview201
          And, these three articles discuss therapies:
http://jaxelection.altervista.org/pancreatic/Acinar25YrsRese
http://jaxelection.altervista.org/pancreatic/AcinarCase2016M
http://jaxelection.altervista.org/pancreatic/AcinarNeoadjuva
2. New therapies.  In posts from recent months you will find 3-4 new agents to consider.  One is CPI-613 which is available under Compassionate Use.  The developer might want an ACC patient.  You should look into all of them quickly.
3. IRE potential.  Ablation methods (like IRE) certainly could be a part of liver resection, depending upon the size of the metastases – IRE is the better procedure if there is blood vessel or duct involvement.  For colon cancer liver resection is not unusual.
          But, for pancreatic adenocarcinoma, surgical / ablation management of metastases is usually not undertaken, too often because the physician considers the Stage 4 patient unsalvageable.  However, the Acinar victim MAY be treated more like the colon cancer patient who is often considered a liver-resection candidate.
4. The IRE practitioners outside the USA are listed in the following documents.  Not all treat pancreatic cancer.  And, many are Interventional Radiologists, not surgeons – a surgeon offers more options, since he may undertake IRE as part of open surgery, laparoscopically or percutaneously (through the skin).  The radiologist is limited to percutaneous IRE.
http://jaxelection.altervista.org/pancreatic/FacilitiesUsing
http://jaxelection.altervista.org/pancreatic/NanoknifeFacili
http://jaxelection.altervista.org/pancreatic/NanoknifePracti
          Surgeon Matthias Birth of Germany has a practice emphasis on IRE and pancreatic cancer.  I have no knowledge of his level of competence or skill.  See
https://translate.google.com/translate?hl=en&sl=de&u
https://www.researchgate.net/profile/Matthias_Birth/publicat
https://www.youtube.com/watch?v=jizQ0e_Hslc
          Don’t rule out treatment in the USA under surgeon Robert CG Martin, who is likely the leading IRE practitioner.  You can get here in a day.  ObamaCare is still accepting enrollees, but you need a specific visa to allow eligibility.  That is covered in a previous post.
5. Clinical trials.  As you know, in Norway there are few clinical trials and no Acinar trials.  Be sure to review those trials nearby and in the USA.  See
https://www.clinicaltrials.gov/ct2/search/advanced
          Finally, be sure to STUDY the last 2 years of posts, which address therapies, care management, avoiding hospital-acquired infections, clinical trial selection and other helpful topics.
         PhilipJax

RE: nanoknife IRE for pancreatic cancer

by dessmo on Mon Aug 21, 2017 04:05 PM

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PhillipJax,

Thank you very much for your extensive and informative answer, to include interesting articles regarding ACC. I will bring this to the table as we discuss further treatment strategy with my medical team. Thank You!

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