IRE with Electrochemotherapy (IRECT) of the prostate—a gentle treatment option for advanced cancers and complex recurrence tumors
IRECT is a new form of therapy to treat prostate cancer. It extends the IRE treatment area, in which the cells get destroyed shortly after the treatment, to a zone in which Reversible Electroporation (RE) occurs (Figure 1). In the area of RE we additionally apply Electrochemotherapy (ECT).
Figure 1: The IRECT treatment area, segmented into IRE (red) and RE (yellow) zone.
The efficiency of Bleomycin is multiplied in the RE treatment area. This occurs due to the increased permeability of the cell wall caused by electroporation, which allows an increased uptake of the chemotherapeutic drug into the tumor cells (Figure 2). This technique is already successfully in use for the treatment of skin and bone tumors.
Bleomycin is a chemotherapeutic drug which can be applied to the treatment of malignant tumors and has been in medical use for many years. An effective treatment with Bleomycin alone normally requires several applications.
The increased effectiveness caused by the Bleomycin extends to the IRE treatment area margins, in which the reversible pore formation is initiated. Without Bleomycin, the Reversible Electroporation in these areas alone is not sufficient to cause cell destruction.
Using IRECT therapy is a new method to treat cancer cells in more distant areas from the IRE electrodes, without causing damage to local organs (e.g. the rectum and bladder sphincter) or tissue. It is therefore the most gentle way of treating large tumor areas.
Indications for carcinoma treatment using combined IRECT therapy
To date the indications for the combined treatment of IRE and Bleomycin are not fully clarified and research is continuing in this area. Only those patients refusing alternative treatment will be treated. Possible uses include:
- Patients with high-grade prostate carcinoma
- Patients with prostate carcinoma which infiltrated the rectum or bladder wall
- Patients with beginning infiltration of the sphincter, which could lead to incontinence
- Patients with complex focal recurrences after surgery, HIFU (High Intensity Focused Ultrasound) or radiation
- Patients with metastases in lymph nodes, bone or in specific cases also metastases in other organs
When the IRE needles are positioned, Bleomycin will be injected. After only 8 minutes the Bleomycin is already distributed throughout the body. Localized and short electrical currents will be applied, producing both the IRE and RE fields. Within the IRE field, all tumor cells will be destroyed immediately afterwards. In the RE field, the tumor cells have a very high Bleomycin uptake, causing them to die within a few hours.
Figure 2: Left: placement of the IRE needles into the prostate. Right: time scale of the ECT treatment. Picture based on a graph by Haberl et al.
After the procedure is completed, you will remain under in-patient care for one night and can leave the hospital the day after. You can return to everyday life a few days afterwards.
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After the successful introduction of the NanoKnife therapy, we have now added an additional treatment procedure to be able to treat large, advanced cancers and complex recurrence tumors in an effective and gentle way.
Every patient is unique, every disease is different. Find out if conventional methods are the right treatment option for you. Our medical specialists will discuss your case and show you all your therapy possibilities.