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Irreversible electroporation (NanoKnife) for pancreatic cancer

Irreversible electroporation (NanoKnife) may be a treatment option for some people with pancreatic cancer.

What is irreversible electroporation and how does it work?

Irreversible electroporation (IRE) is a treatment that involves inserting needles into and around the cancer. High voltage electrical currents are passed between the needles. These currents damage and destroy the cancer cells.

IRE is sometimes known as NanoKnife®, which is the brand name for the machine used to deliver the treatment.

IRE aims to shrink and try to destroy the cancer. This can help to control symptoms, such as pain. It also aims to help people live longer. For a small number of people, it may shrink the cancer enough for surgery to be possible – although we need more research into this.   

It’s important to remember that there has not been much research into IRE for people with pancreatic cancer. There have only been a few small studies, which means that we don’t know enough about how effective it is, and who it is most suitable for. The National Institute for Health and Care Excellence (NICE) has said that at the moment IRE should only be used in research studies looking at how well it controls pancreatic cancer.

Who can have IRE?

NanoKnife is usually used for people who have already had chemotherapy, and also sometimes radiotherapy.

It may be suitable for some people with locally advanced inoperable pancreatic cancer. This is cancer that can’t be removed by surgery and has spread to nearby structures such as blood vessels around the pancreas.

Sometimes, IRE might be used for people with cancer that has spread to some places outside the pancreas, for example if it is close to the bile ducts. It may be available privately for people with pancreatic cancer that has spread to the liver (liver metastases), but it is not available on the NHS for this.

Whether it’s suitable for you may depend on your own situation. For example, you will need to be fit enough to have a general anaesthetic. It may also depend on what other treatments you’ve already had, or how big the tumour is. IRE is only suitable if the tumour is less than 4cm long. This is because it can be difficult to put in enough needles to treat larger tumours, so some of the tumour may not be treated.

Speak to your doctor if you have had a metal stent fitted. These are used to treat a blocked duodenum (first part of the small intestines) or bile duct. It may still be possible to have IRE if you have a metal stent – but there may be a higher risk of problems or side effects, and the treatment may not work so well. Plastic stents don’t cause problems with IRE.

IRE is not recommended if you have an irregular heartbeat (atrial fibrillation), and you won’t be able to have IRE if you have a pacemaker. This is because the electrical currents can affect the heartbeat.

Speak to your doctor about whether IRE might be an option for you.

How can I have IRE?

In the UK, NanoKnife is only available in a few NHS hospitals. It may also be available privately.

Talk to your doctor about whether IRE might be suitable for you, and whether you might be able to get it. If it is suitable for you, but isn’t available at your hospital, your doctor may be able to refer you to a hospital that does IRE. Or speak to our specialist nurses on our Support Line for more information about this treatment, where it is available, and how to access it.

Read more about what treatment with NanoKnife involves.

Published October 2015

To be reviewed October 2017

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