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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)
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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
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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
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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
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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
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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
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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
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+ −
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
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+ −
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)
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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
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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
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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
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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
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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)
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不可逆轉電穿孔(納米刀)儀器The Nanoknife equipment
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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)
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不可逆轉電穿孔(納米刀)儀器The Nanoknife equipment
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動物實驗 Animal study
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大腿肌肉 動脈 靜脈 神經線Groin muscle, artery, vein, nerve
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大腿肌肉 動脈 靜脈 神經線Groin muscle, artery, vein, nerve
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大腿肌肉 動脈 靜脈 神經線Groin muscle, artery, vein, nerve
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大腿肌肉 動脈 靜脈 神經線Groin muscle, artery, vein, nerve
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胰腺癌 Pancreatic cancer
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電腦掃描 CT Scan
納米刀前Before Nanoknife
納米刀一天後One day after
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正離子掃描 PET Scan
納米刀前Before Nanoknife
納米刀三週後3 Weeks after
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治療後三週傷口狀況Wound condition after 3 weeks