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How Electrical Pulses Can Target Cancer Cells · Meaningful Medicine with Novant Health

• 0:03
  Joey (Host): It's an advanced way of treating cancer.
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  So we're discussing the nano knife procedure.
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  Our guest is Dr.
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  Michelle Fillion.
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  specializing in complex general surgical oncology.
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  This is Meaningful Medicine, a Novant Health Podcast, bringing you
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  access to leading doctors who answer questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
• 0:29
  decisions and build a healthier future.
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  Thanks so much for joining us.
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  I'm Joey Wahler.
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  Hi, doctor.
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  Welcome.
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  Michelle Fillion, MD: Thank you for having me.
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  Joey (Host): Great to have you board.
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  Appreciate the time.
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  So first, being a surgical oncologist, you naturally work
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  alongside other specialists.
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  Treating cancer patient's could include radiation oncologists, medical-oncologist.
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  So can you discuss a little bit about that multidisciplinary approach?
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  Michelle Fillion, MD: Yeah, that, that really is the cornerstone for any
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  kind of treatment for, uh, the cancer patient, especially, patient's who have
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  more complex disease, processes or.
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  Intraabdominal tumors or that are either in the liver, the pancreas,
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  we really have to work as a team in order to best, determine the treatment
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  modality And the sequencing of that treatment modality for those patient's.
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  Joey (Host): So as mentioned, we're focusing here on a
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  treatment modality you're now offering in the Wilmington area.
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  It's called Nano knife, irreversible electroporation.
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  So in a nutshell, how does this technology work?
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  Michelle Fillion, MD: to break it down with you.
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  It's a way that we can ablate or destroy the cancer cells,
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  but not using a heat source.
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  so it's called a non-thermal ablation that we can.
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  Kill the cells without having to actually cut out that organ.
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  it's used complimentary.
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  We can either use it with, surgery or without surgery, but it's offering a
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  different treatment that we didn't have in this region before, which is not using
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  heat or a non-thermal ablative technology where we have some of those thermal
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  technologies that we can already use.
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  Joey (Host): So, speaking of which doctor, part of the goal here, of course, is to
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  spare that surrounding healthy tissue.
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  So can you talk a little bit about the importance of such.
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  Preciseness here.
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  Michelle Fillion, MD: Yeah, And so when we use these technologies, we use image
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  guidance, And so you can use ultrasound guidance to help find the lesions.
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  You can also use CT scan guidance in if we're using it in the
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  operating room as an adjunct or a.
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  In assistance with surgery, we're using ultrasound guidance to help
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  place the probes or their little antennas that are either at the
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  tumor or adjacent to the tumor.
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  So then we can conduct, the electroporation and
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  kill those cells real-time.
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  We can watch with the ultrasound, the tumor, get distracted, And we can see it
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  in acro, kind of in front of our eyes.
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  We can then go back if there needs to be a touchup or a second worth.
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  Third treatment.
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  We can do that real-time based on what we're seeing with the image guidance.
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  Joey (Host): Gotcha.
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  So that being said, what types of conditions, what kinds of tumor
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  specifically can surgeons like you use the nano knife technology to treat?
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  Michelle Fillion, MD: Yeah, so right now there's um, pretty strong
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  indications for using it in the liver.
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  And that can be done with primary liver cancer.
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  for example, if somebody has, it's unresectable due to its location or
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  if, they have significant cirrhosis and not just a good surgical
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  candidate, we can use this to ablate.
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  And especially if it's near, adjacent blood vessels or bile ducts that.
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  We didn't wanna use the thermal methods for.
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  It can also be used for colon and rectal, metastasis or spread to the
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  liver so we can ke treat cancers that a spread to the liver as well.
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  There's also, ways it's a little bit more emerging is to treat pancreatic
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  cancer tumors to help kind of treat the margins so we can make sure we
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  get, complete tumor clearance and decrease the risk of it coming back.
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  there are urologists that specialize in prostate cancer that can also be
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  using this, where tumors that are very adjacent to the urethra to help
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  prevent some stenosis or having men having difficulty passing their urine.
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  so that's another area that we could use this technique.
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  Joey (Host): So while the nano knife uses electrical pulses, there are also those
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  thermal ablations you've touched on.
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  Can you explain a little bit about the main difference between.
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  Those two.
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  And are there any benefits in certain cases to using one or the other?
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  Michelle Fillion, MD: Yeah.
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  And so the big thing is to add to our region is that we have a non-thermal
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  ablative technology, And so when these electrical pulses shoot together, they
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  disrupt the cell's membrane to the point where we're literally just shooting
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  holes in the cell's membrane to the port.
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  point that it can't repair and those cells end up dying.
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  So again, you wanna be very specific on treating those cells, but they don't
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  penetrate the extracellular matrix of, say blood vessels, bile ducts, nerves.
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  So those tissues do get spared.
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  so that's where it really comes into a benefit.
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  If you did, uh, an ablative technology such as a microwave ablation
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  or a radiofrequency ablation, you have to be very careful.
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  Do the surrounding blood vessels or, Bile duct urethra because you
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  can get thermal damage and cause long-term damage to those structures.
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  Joey (Host): Now you also use ablations as a primary treatment or
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  in conjunction with a tumor removal.
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  So can you explain that, including the importance of negative
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  margins as they're known.
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  Michelle Fillion, MD: Yes, our first.
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  goal is to always try to remove the cancer.
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  So that's the main principles.
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  If we can always remove it, that's the best treatment.
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  If we can't remove it, then we can start to use these ablative technologies.
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  and it's not one or the other.
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  So there's also a middle ground is if we want to remove it, but we're
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  concerned about having close margins.
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  And the key to a good resection is having negative margins 'cause you
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  don't want that tumor to come back.
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  You can use these technologies to help augment or get a wider margin that
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  maybe would be difficult surgically due to those vascular structures or
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  bile ducts that would be in the way.
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  So this would allow us to treat that margin that couldn't safely
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  be removed, but while killing the cancer cells to ultimately get
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  us to have that negative margin.
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  And for patient's that are unresectable, then we would
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  principally treat them with the, uh.
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  IRE, the irreversible electroporation, but the goal is always, if we can
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  resect it, is to physically remove it.
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  Joey (Host): How about are there any cancers for which
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  nano knife is not an option?
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  Michelle Fillion, MD: probably a whole host of cancers that can't, like the
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  strong indications would be, in the liver, in the pancreas, And in the
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  prostate or where there are, approval to be using those type of, modality,
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  I believe kidney cancer may be one that's coming down the pike as well.
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  so.
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  There's more cancers that are out there.
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  But those specific organs, there is FDA clearance to be using
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  this technology in those organs.
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  Joey (Host): All right.
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  Couple of other things for you, since you've been using this technique, what
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  kind of feedback have you gotten from patient's and how rewarding is it to be
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  able to offer this in the first place?
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  Michelle Fillion, MD: Well, it, it's a whole nother modality.
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  It gives us more options.
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  So if we need to pivot real-time, say we're in the operating room,
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  we're planned resection, and if we can't go forward with it.
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  We have an option to real-time pivot and still get the cancer treated on the table
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  without having to have the patient come back, schedule a different treatment, or
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  be referred out of the area to get this.
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  Cancer treated.
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  So it's offering us abilities to stay in the area.
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  and most of the time the patient's tolerate it quite well.
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  very, very low risk.
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  Biggest risk is obviously bleeding 'cause we're putting
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  in, uh, probes into the organs.
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  And then we also just work with our anesthesia docs.
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  'cause these are procedures that would require anesthesia as well.
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  Joey (Host): And of course, as you know.
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  Well, as anyone, doctor, cancer patient's, when they're going through
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  it, they're going through a lot more than just the cancer, right?
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  There are all kinds of distractions and other issues that need to be dealt
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  with in someone's life as a result of cancer, perhaps losing a job,
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  family care, et cetera, et cetera.
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  The list goes on and on.
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  So to be able to make the procedure itself of removing the cancer as quick
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  and easy as possible, that's gotta be very comforting for people, right?
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  Michelle Fillion, MD: Oh my gosh.
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  Of course.
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  I mean, And so, and if we can do things, as minimally invasive as possible.
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  That would be ideal.
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  And for those patient's that wouldn't be a surgical candidate that we knew upfront,
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  these probes can be done what we call percutaneously, kind of going through the
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  skin, so they can be treated a, a as well.
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  so that's really limiting kind of that downtime.
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  But it's great to see the patient's.
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  Our goal is to get them back in a good functional status so they
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  can be enjoying their lives.
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  Joey (Host): And then in summary here, doctor, what would you say you
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  and yours at Novant Health in your department And this specialty, what
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  do you really hang your hat on that you're most proud of, that you want to
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  convey to those joining us in case they do have to go through this procedure?
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  Michelle Fillion, MD: It's just that, that we care.
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  We really truly care, And we wanna see you succeed.
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  Like that's where I get the most, the most joy, is that if I can get your
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  cancer treated, and I'm seeing you years later and I'm learning more about
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  your stories, where have you traveled?
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  Have you visited your grandkids?
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  That you have gotten meaningful?
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  Life, just growth and life experiences that gives me joy.
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  And so the goal is to get there and to get patient's a new lease on life by
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  getting their cancer treatment completed.
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  Joey (Host): Absolutely.
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  Well folks, we trust you are now more familiar with the Nano Knife procedure.
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  Dr.
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  Fillion, keep up all your great, in this case, groundbreaking
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  work and thanks so much again.
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  Michelle Fillion, MD: you so much for having me.
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  Joey (Host): Absolutely.
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  And to find a physician, please visit novant health.org.
• 9:51
  For more health and wellness information from our experts,
• 9:54
  please visit healthy headlines.org.
• 9:56
  If you found this podcast helpful, we ask that you please
• 9:59
  share it on your social media.
• 10:01
  I'm Joey Wahler, and thanks so much again for being part of Meaningful
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  Medicine, a Novant Health Podcast.