治癌新突破：...

余俊豪醫生 Dr. Simon Yu

透視微創治療基金臨床科學中心總監Director, Vascular and Interventional Radiology Foundation Clinical Science Center

影像及介入放射科教授Professor, Department of Imaging and Interventional Radiology

治癌新突破：不可逆轉電穿孔（納米刀）

New Breakthrough in Cancer Treatment: Irreversible electroporation (Nanoknife)

肝癌 Liver cancer以往：外科切除＝最佳治療Old concept: surgical resection = best treatment

消融技術治療癌症Ablative therapy for cancer treatment

肝癌 Liver cancer現在：3－5公分以下腫瘤

熱能消融＝外科切除New concept: Thermal ablation = surgical resection (≤3-5cm)

消融技術治療癌症Ablative therapy for cancer treatment

Portal pressure/bilirubin

Ablation Sorafenib

PS 0, Child–Pugh A

Very early stage (0) Single< 2 cm

Early stage (A)Single or 3 nodules

< 3 cm, PS 0 

End stage (D)

Transplant TACEResection

Associated diseases

YesNo

3 nodules ≤ 3 cm

↑

Normal

Single

PS > 2, Child–Pugh C

Intermediate stage (B)Multinodular,

PS 0

Advanced stage (C) Portal invasion, N1, M1, PS 1–2

PS 0–2, Child–Pugh A–B

HCC

BCLC staging system and treatment strategy

adapted from Bruix J, Sherman M. Hepatology 2011;53:1020-2

Extrahepatic metastasisMain portal vein tumor thrombus

Solitary or multifocal tumor in noncirrhoticliver or Child A cirrhosis

Sorafenib or systemic therapy trial

Resection / RFA (for

< 3 cm HCC)

Solitary tumor ≤ 5 cm ≤ 3 tumors ≤ 3 cmNo venous invasion

Child A                      Child  B                     Child  C                            Child  A / B Child’s C    

Transplantation TACE Supportive careLocal ablation

Confined to the liverMain portal vein patent

Tumor > 5 cm> 3 tumors

Invasion of hepatic / portal vein branches

Asia-Pacific Association for Study of Liver Consensus on Treatment of HCC

Yes No

Child A / B Child C

Omata et al. Hepatol Int 2010

熱能消融的限制Limitations of thermal ablation

破壞膽管，膽囊 膽管閉塞，膽囊破損Thermal damage to bile duct, Occlusion of bile ductgallbladder Gallbladder perforation

血管的散熱作用減弱治療效果 腫瘤殘餘，腫瘤復發（血流溫度37度＝〝降熱效應〞) Residual tumor, Heat sink effect Tumor recurrence

不可逆轉電穿孔（納米刀）運作原理Mechanism of action of Nanoknife

電極針 高壓電場（3000伏特 Volt）Electrode needles produce high electric voltage

+ −

不可逆轉電穿孔（納米刀）運作原理Mechanism of action of Nanoknife

電極針 高壓電場（3000伏特 Volt）Electrode needles produce high electric voltage

+ −

不可逆轉電穿孔（納米刀）運作原理Mechanism of action of Nanoknife

超短脈衝直流電 （2/100至1/10秒）Ultra-short electric pulses (20-100 microseconds)

納米孔 細胞凋亡Nano-holes Cell apoptosis

不可逆轉電穿孔（納米刀）運作原理Mechanism of action of Nanoknife

已凋亡的細胞分解 被巨噬細胞吸收Cell apoptosis Cleared by phagocytes

不可逆轉電穿孔（納米刀）運作原理Mechanism of action of Nanoknife

不可逆轉電穿孔（納米刀）運作原理Mechanism of action of Nanoknife

已凋亡的細胞分解 被巨噬細胞吸收Cell apoptosis Cleared by phagocytes

納米刀的優點 Advantages of Nanoknife

射頻消融(熱能)治療 腫瘤細胞壞死 疤痕Thermal ablation Tumor cell necrosis Scar

納米刀 腫瘤細胞凋亡 正常細胞取代Nanoknife Apoptosis Normal cell replacement

不可逆轉電穿孔(納米刀)儀器The Nanoknife equipment

心電波監測器(Electrocardiac monitor)

電極針 (Electrode needle) 電流發射機(Generator)

不可逆轉電穿孔(納米刀)儀器The Nanoknife equipment

不可逆轉電穿孔(納米刀)儀器The Nanoknifeequipment

消融範圍(Ablation zone)：4公分(cm) X 5公分(cm) X 5公分(cm)

不可逆轉電穿孔(納米刀)儀器The Nanoknife equipment

1

23

4

超聲波影像 Ultrasound

動物實驗 Animal study

大腿肌肉 動脈 靜脈 神經線Groin muscle, artery, vein, nerve

大腿肌肉 動脈 靜脈 神經線Groin muscle, artery, vein, nerve

大腿肌肉 動脈 靜脈 神經線Groin muscle, artery, vein, nerve

大腿肌肉 動脈 靜脈 神經線Groin muscle, artery, vein, nerve

腎臟 Kidney

腎臟 Kidney

腎臟 Kidney

腎臟 Kidney

肝臟 Liver

肝臟 Liver

肝臟 Liver

肝臟 Liver

胰腺癌 Pancreatic cancer

電腦掃描 CT Scan

納米刀前Before Nanoknife

納米刀一天後One day after

正離子掃描 PET Scan

納米刀前Before Nanoknife

納米刀三週後3 Weeks after

治療後三週傷口狀況Wound condition after 3 weeks