Interventional Radiologist Stephen Solomon
Cancer researchers constantly strive to expand the arsenal of weapons to treat the disease, particularly for people with tumors that aren’t responsive to conventional treatments. One such option is a minimally invasive approach called thermal ablation, which involves placing a needle into a tumor and applying extreme heat or cold, which kills the cancer while preserving healthy tissue. In addition to destroying tumors, thermal ablation may actually activate immune cells to attack the cancer.
Memorial Sloan Kettering now has one of the biggest ablation programs in the United States, says Stephen Solomon, Chief of the Interventional Radiology Service and Director of the Center for Image-Guided Interventions. “We’re treating approximately 300 people a year, frequently on an outpatient basis that allows patients to go home after the procedure the same day.”
However, thermal ablation cannot be used in some patients.
“Thermal ablation can cause scarring in healthy tissue near the tumor, making it inappropriate for use on some tumors near blood vessels, nerves, bile ducts, and other sensitive structures,” says Mikhail Silk, a medical student at SUNY Downstate College of Medicine, in Brooklyn, who is conducting research in collaboration with the Interventional Radiology Service. “It also can fail to kill every cancer cell if the tumor abuts a major blood vessel because blood flow dissipates some of the extreme heat or cold emitted from the needle — a phenomenon called the heat sink effect.”
Punching Holes in Cells
Now a new, minimally invasive treatment that uses an electric current to punch tiny holes in cancer cell membranes is showing promise against challenging tumors. Called irreversible electroporation (IRE), the technique uses tiny needles to give cancer cells a jolt of electricity.
The electricity produces holes in the cell membranes, which disrupts the balance of molecules inside and outside the cells. IRE causes no scarring or inflammation in nearby healthy tissues, and there is no heat sink effect.
“Blood vessels and nerves are made not just of cells but also have protein structures surrounding them,” Dr. Solomon explains. “Because proteins don’t have electric membrane potential, these structures are largely protected from IRE, making it possible to destroy a tumor safely without destroying the structural integrity of an organ.”
IRE holds particular potential for treating liver, lung, and pancreatic cancers that are close to blood vessels and other sensitive structures — situations in which normal heat or cold ablation is not feasible.
Back to topEncouraging Study Results
After validating the safety of IRE in animal studies, Memorial Sloan Kettering’s interventional radiologists and surgeons have begun using the procedure in select patients who are not eligible for other treatments — particularly, patients with cancer that has spread to the liver from other sites in the body.
Early results suggest IRE can be effective and safe. In the January 2014 issue of the Journal of Vascular Interventional Radiology, Dr. Solomon’s team reports that IRE was used successfully in 11 patients to treat a total of 22 small tumors that had spread to the liver from other locations. In 15 treatment sessions, the tumors — which had a median size of 3 centimeters — were destroyed with no major complications. Many of the tumors were located less than 1 centimeter from bile ducts, making thermal ablation too risky.
Memorial Sloan Kettering specialists will continue to explore IRE in other types of cancer, although in every case it needs to be compared with thermal ablation and other minimally invasive treatments. Dr. Solomon’s team recently received a grant from the National Institutes of Health to investigate the use of IRE in lung cancer, which they hope to begin in 2014.
A strong feature of the Interventional Radiology Service has been the addition of a biomedical engineer, Govind Srimathveeravalli, who has worked with the clinical team to optimize the use of IRE.
“For complete tumor destruction with IRE, it is important to achieve a uniform electric field within the target region,” Dr. Srimathveeravalli says. “As tumors are heterogeneous in nature, treatment planning for IRE can be a challenge to physicians. I use physics simulations and work with Dr. Solomon to develop guidelines for optimizing treatment plans. We also perform research to develop new devices that will extend the reach of IRE therapy to new anatomical locations.”
“Our research program will be focusing a lot of energy on developing and refining IRE over the next few years,” Dr. Solomon adds. “There are still important questions that need to be answered — such as whether IRE actually destroys all the cancer cells — but we hope it becomes another tool that physicians can rely on when nothing else is suitable.”
Back to topComments
Mary1233
Jan 28, 2014 • 9:29 AM
Memorial Sloan Kettering
Jan 28, 2014 • 10:57 AM
In reply to Can this be used on tumors in by mary1233
Elizabeth Munroz
Jan 28, 2014 • 3:36 PM
Memorial Sloan Kettering
Jan 28, 2014 • 4:16 PM
In reply to What is it about liver, lung, by Elizabeth Munroz
Pat Grooms
Jan 30, 2014 • 6:08 PM
Memorial Sloan Kettering
Jan 30, 2014 • 8:27 PM
In reply to what about a primary tumor as by pat Grooms
Keith McIntyre
Jan 30, 2014 • 7:27 PM
Memorial Sloan Kettering
Jan 31, 2014 • 9:45 AM
In reply to Would this treatment work on by Keith McIntyre
Gordon Single, MD
Jan 31, 2014 • 3:15 PM
Jeff Royall
Feb 2, 2014 • 4:23 PM
I was diagnosed with Stage IV Colon / Liver cancer in June of 2013. I've finished round 11 of chemotherapy and will soon reach number 12. At that point, my medical team will decide if I'm to receive liver directed chemo, radiation implants to the liver, or just continue on maintenance chemo program?
I'm very interested in the possibility of this procedure in the very near future if its available now for use?
I am insured, and am willing to do what ever is necessary for a second chance at life.
Memorial Sloan Kettering
Feb 2, 2014 • 5:56 PM
In reply to I was diagnosed with Stage IV by Jeff Royall
Jeff, thank you for your comment. If you would like to make an appointment with a Memorial Sloan-Kettering physician, please call our Physician Referral Service at 800-525-2225 and explain the details of your situation or go to http://www.mskcc.org/cancer-care/appointment.
Felix J. Otero
Feb 6, 2014 • 1:36 PM
Greetings. My mother is a 58 years old female. She has recurrent/rectal cancer at 1 cm from anal verge. She had TAE/TAMIS on 7/16/2013. Pathology 3 cm tumor, T2 (invades through muscular propria, + LVI, no LN seen) T2NXMX, distal margin + on September 2013, she had a colostomy for colonic obstruction. On January 31, 2014, she was subjected to a Laparascopic APR with Lymphadenectomy. Unfortunately, this wasn't concluded since apparent
metastasis (Pelvis) was present (No Vital organs at this point). She has been referred for Chemotherapy.
My question is. Is she a possible candidate for IRE? We are ready to travel since we are from Puerto Rico. Please let us know. We are so anxious with all this situation.
v/r
Memorial Sloan Kettering
Feb 6, 2014 • 1:59 PM
In reply to Greetings. My mother is a 58 by Felix J. Otero
Dear Felix, we are sorry to hear about your mother’s recurrence of rectal cancer. The technology is still experimental and it is currently being used in cases where doctors have few other options.
If you would like to make an appointment for your mother to have a consultation with one of our physicians, please call our Physician Referral Service at 800-525-2225.
Thank you for reaching out to us.
Judy
Feb 9, 2014 • 10:13 AM
Judy
Feb 9, 2014 • 11:49 AM
Maxwell Dareus
Feb 24, 2014 • 8:33 PM
Great work! keeping the bad guys out of the human body is a challenging task. when that challenge is met effectively, lasting joy and contentment is what stays with a former patient who might have been hopeless prior to treatment. My current focus is the human heart. I am not an expert, but the materials that I consult gives me knowledge that I did not really acquire during my bio courses. Congrats! if you would allow me to. I hope the IRE technique proves to be effective for the targeted major organs.
Eugene
Mar 1, 2014 • 11:37 PM
Dear Eugene, we are sorry to hear about your wife’s diagnosis. We cannot answer personal medical questions on the blog, but in general, the technology is still experimental and it is too early to say which types of cancer it will be effective in treating. It is currently being used in cases where doctors have few other options.
If your wife would like to make an appointment for a consultation with one of our physicians, please call our Physician Referral Service at 800-525-2225.
Thank you for reaching out to us.
Patricia Conrad
Apr 15, 2014 • 4:07 PM
Memorial Sloan Kettering
Apr 17, 2014 • 8:50 AM
In reply to Can I.R.E. be performed on by Patricia Conrad
Elena
Apr 29, 2014 • 2:09 PM
Can you, please, tell little more about possibility o using this technology for brain tumors - what do you think about it? Did you try it or may be theoretically planing? It is have some hope - becouse it still no big progress in the brain tumor treatments and it is very important to create new possibility for that. What do you think about it? Thank you!
Elena, thank you for reaching out to us. In general, this technology is still experimental and it is too early to say which types of cancer it will be effective in treating, including brain tumors. It is currently being used in cases where doctors have few other options.
If your wife would like to make an appointment for a consultation with one of our physicians, please call our Physician Referral Service at 800-525-2225.
Thank you for reaching out to us.
Elena
Apr 29, 2014 • 2:28 PM
Elena
Apr 29, 2014 • 5:34 PM
Derrick
May 9, 2014 • 6:23 AM
My 2.5 yo daughter was just diagnosed with Stage IV Alveolar Rhabdomyosarcoma by Texas Childrens in Houston. She has 3 masses, one near her rib cage, another near her kidney and a small area near a rib that has not done any damage to the bones. The larger of the 2 is near her ribs and is less than 5CM. Would it be possible to use this method to damage the 2 tumors enough to cause them to stop growing/initiate apoptosis? She has not been treated with Chemo medicines or radiation yet and I have been researching medical data that could be used to treat her specific type of cancer without damaging her immune system. They want to start treatment on Monday. Can you provide me with more information about this procedure. I understand its experimental but there have been no other alternatives presented to me besides textbook answers off the cancer.org site.
Derrick Smith
Jun 2, 2014 • 11:49 AM
Follow-up: We advised the oncology team at Texas Childrens to get in contact with you and they said no one from your hospital has called them back. We gave them the direct link to this post for reference after you responded to my question. Is there a direct contact that we can forward them to in regards to consultation?
Memorial Sloan Kettering
Jun 2, 2014 • 12:46 PM
In reply to Follow-up: We advised the by Derrick Smith
Derrick, we recommend that you have the oncology team contact our Physician Referral Service at 800-525-2225 and explain the specifics of the case and that they are seeking a consultation with an MSK expert regarding this type of procedure. Thank you for your comment.
Frank Landivar
Jun 10, 2014 • 8:09 PM
My mom is under the care of Dr. Strong Surgen and Dr. Olsen oncologist for stage four stomach cancer that has spread to her colon and liver after opening her two weeks ago to remove tumor from her stomach that was originally diagnose as stage two stomach cancer. I would like Doctor Solomon opinion and consultation to see if his new IRE will benefit my mother.
Thank you
Frank Landivar Son
Memorial Sloan Kettering
Jun 10, 2014 • 9:26 PM
In reply to My mom is under the care of by Frank Landivar
Robert
Jul 10, 2014 • 7:53 PM
Jasmine Pelloni
Jul 31, 2014 • 10:52 PM
Memorial Sloan Kettering
Aug 1, 2014 • 8:22 AM
In reply to My Mother has bile duct by Jasmine Pelloni
Dear Jasmin, we are sorry to hear about your mother’s diagnosis. To make an appointment with one of our specialists and discuss appropriate treatment options, please call our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.
Mike Bolduc
Aug 1, 2014 • 11:25 AM
Hi Doctors, thank you for your dedicated service and thank you for taking my question. I have small cell cancer which was discovered approximately 3 years ago and my Dr. is somewhat surprised at my survivability. The tumor is where my bronchial tubes branch out (the crux) and it has responded reasonably well to chemo up to this point. Because it has begun to grow my Dr. feels the is present chemo is not effective. My Dr. says the cancer is not acting the way small cell cancer normally acts. The tumor is pressing directly on one bronchial tube and partially on a second one inhibiting breathing to some extent. The next move he is suggesting, after having consulted with a pulmonologist ( I also have consulted on one occasion and a second is scheduled) that a stent(s) be placed in the bronchial tubes and a direct injection of chemo into the tumor by going through the bronchial tube and directly into the tumor. Have you had experience in this direct injection procedure and it's effectiveness or do you think the IRE procedure would be more effective? Thank you so much for taking time to review and answer my question. Take care.
Sincerely,
Mike Bolduc
Dear Mike, thank you for reaching out to us. Unfortunately, we cannot give personal medical advice over our blog. If you would like to make an appointment with one of our interventional radiologists, you can call 800-525-2225 or you can get appointment information here: http://www.mskcc.org/cancer-care/appointment. Thanks again for your question.
Meg
Aug 17, 2014 • 10:45 PM
Is there anyone doing this on metastatic breast cancer tumors in the bone. I have two that are causing trouble: a painful one in my upper arm, and also one at the base of the skull that is causing some numbness in my face.
And/or can you recommend someone who does this in Washington/Oregon. Or I could come to NYC.
Thank you!
Dear Meg, we reached out to Dr. Solomon about your question. He had this to say: “Yes we do this, however, the one at the skull base may be too difficult. We would need to review imaging. They may be able to help at Oregon Health Sciences Center.” If you’d like to make an appointment at Memorial Sloan Kettering, the number is 800-525-2225, or you can learn more here: http://www.mskcc.org/cancer-care/appointment. Thanks so much for your question, and we wish you all the best.
Meg
Aug 18, 2014 • 1:25 PM
Dr. Solomon suggests you try Ken Kolbeck at the Dotter Interventional Institute: http://www.ohsu.edu/dotter/kolbeckk.htm
Linda
Aug 26, 2014 • 9:36 AM
Linda, we cannot answer specific medical questions on the blog, but in general, the technology is still experimental and it is too early to say which types of cancer it will be effective in treating.
If you’d like to make an appointment for a consultation with one of our physicians, please call our Physician Referral Service at 800-525-2225. Thank you for your comment.
Linda Garone
Aug 28, 2014 • 10:28 PM
Memorial Sloan Kettering
Aug 29, 2014 • 7:49 AM
In reply to Is turmeric helpful with by Linda Garone
Linda, you can learn more about turmeric on our About Herbs database. You’ll find it here: http://www.mskcc.org/cancer-care/herb/turmeric Thank you for your comment.
Jasmine Pelloni
Sep 16, 2014 • 4:07 PM
Memorial Sloan Kettering
Sep 16, 2014 • 4:27 PM
In reply to My Mother's records have been by Jasmine Pelloni
Jasmine Pelloni
Sep 16, 2014 • 4:39 PM
Can this be used on tumors in the brain