What is IRE (Nanoknife) for pancreatic cancer?
IRE is sometimes known as NanoKnife®, which is the brand name for the machine used to deliver the treatment.
IRE for pancreatic cancer involves inserting thin needles around the cancer in your pancreas. High voltage electrical currents are passed between the needles. These currents damage and destroy the cancer cells.
The aim is to slow the growth of pancreatic cancer by destroying the cancer cells. This may help people live longer. It can also help control symptoms such as pain.
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 well it works, who it is most suitable for, and the side effects and complications. 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. Researchers are planning to set up a clinical trial to look at IRE for pancreatic cancer. Until there is a clinical trial available, NHS hospitals that provide IRE are helping to collect information about how well it works. Read more about clinical trials for pancreatic cancer.
Locally advanced pancreatic cancer
IRE may be suitable for some people with locally advanced 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. The aim of IRE is to slow the growth of the cancer, to help people live longer and to treat symptoms.
Borderline resectable pancreatic cancer
IRE may also be suitable for some people with borderline resectable pancreatic cancer – although this may only be an option for a small number of people at some of the hospitals that provide IRE.
Borderline resectable cancer is cancer that has grown very close to or around the major blood vessels near the pancreas. It may be possible to remove the cancer with surgery, but it depends which blood vessels are affected and how far the cancer has grown. IRE doesn’t damage structures such as the blood vessels and the bile duct (tube the carries bile from the liver) that are near to the pancreas, so can sometimes be used on tumours that are close to these structures. The aim is to try to kill the cancer cells near the blood vessels, to increase the chances of removing the tumour successfully during surgery. This will happen for only a few people. It is known as margin accentuation.
Some people with borderline resectable cancer may be offered surgery to remove the cancer, but during the operation the surgeon finds the cancer has grown too close to major blood vessels to remove it. Although it’s not possible to remove the tumour, IRE may be used during the operation to treat the tumour. You may then be offered chemotherapy once you have recovered from the operation.
We don’t know much about IRE for borderline resectable pancreatic cancer and we need more research into this. If this is an option for you, your doctor will discuss it with you.
What else can affect who IRE is suitable for?
Whether IRE is suitable for you will 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. It can be difficult to treat the whole tumour if it is larger.
If you have had a metal stent fitted to treat a blocked duodenum (first part of the small intestines) or bile duct, this could interfere with the electrical current during IRE and cause problems or side effects. Your doctors may replace the metal stent with a plastic stent before you have IRE. Plastic stents don’t cause problems with IRE.
IRE may not be suitable if you have an irregular heartbeat (atrial fibrillation), a pacemaker or other types of heart problems such as congestive heart failure or coronary artery disease. This is because the electrical currents can affect your heartbeat. Speak to your doctor about this. They may need to do an assessment to check whether you are fit enough for IRE.
Speak to your doctor about whether IRE might be an option for you. It’s important to talk it through with them before making any decisions about your treatment.
At the moment, IRE is only available in a few NHS hospitals. 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 provide IRE. Speak to your doctor about this.
Accessing IRE can sometimes be complicated. You can speak to our specialist nurses on our Support Line for more information about IRE, where it is available, and how to access it.
Updated: May 2018
Review Date: May 2020