nanoknife IRE for pancreatic cancer

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RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Mon Oct 30, 2017 01:06 AM

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New NCCN Guidelines v 3.2017
New IRE Guidance System

Everyone:
          Two new items of interest.
>> NCCN. NCCN has issued its third edition for 2017, which is available here:
http://jaxelection.altervista.org/pancreatic/NCCN3.2017Pancr
          This is only the second edition which cites Irreversible Electroporation (IRE).  More below.
>> 3D IRE Guidance.  As you may know, effective IRE performance requires precise placement of the needles.  In the following article Robert CG Martin presents the advantages of a new 3D guidance system.  Your IRE practitioner should be using this system.  See
http://jaxelection.altervista.org/pancreatic/IRE3DNeedleLoca

How to Use the NCCN Guidelines

          NCCN is used by physicians to make treatment decisions.  You can learn whether your physician is applying the best available therapy.  But, it takes real work (which reduces suffering in the long run).
          Every care manager MUST study the document carefully (and study the last two years of posts on this website).
          The following is a list of NCCN features by page number.  You should study the guide in the following order:
> Pg-4, the new Evidence Block system
> Pg-43, The ranking of chemo regimens using Evidence Blocks.  Focus on the far-left column: Efficacy.
> Pg-46, Staging code.  This coding (and no other), to this detail, should appear in the overall-condition and biopsy reports.
> Pg-47, Details of the disease and therapies.  Note well the Categories of Evidence and Consensus, upper left, Page 47.  Category-1 is, of course, the best.
> Pg 99, Genetic Syndromes and Risk.
> Pg-100, Indications for specific therapies.
> Pg0107, Referenced.  Here you will find treatment leaders AND physicians you may wish to seek for treatment.
> Pg-2, Oncology leaders who authored this guideline.  They are physicians you may wish to consult for treatment.
> Pg-6, Physician decision tree. With the exception of IRE, your physicians should be following this decision tool.

To the detriment of their patients, nearly half of treating physicians ignore these guidelines.  See
http://jaxelection.altervista.org/pancreatic/9_Pancreatic201
http://jaxelection.altervista.org/pancreatic/7_MDAnderson201
         PhilipJax

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Mon Oct 30, 2017 10:18 AM

Quote | Reply

New NCCN Guidelines v 3.2017
New IRE Guidance System

Everyone:
          Two new items of interest.
>> NCCN. NCCN has issued its third edition for 2017, which is available here:
http://jaxelection.altervista.org/pancreatic/NCCN3.2017Pancr
          This is only the second edition which cites Irreversible Electroporation (IRE).  More below.
>> 3D IRE Guidance.  As you may know, effective IRE performance requires precise placement of the needles.  In the following article Robert CG Martin presents the advantages of a new 3D guidance system.  Your IRE practitioner should be using this system.  See
http://jaxelection.altervista.org/pancreatic/IRE3DNeedleLoca

How to Use the NCCN Guidelines

          NCCN is used by physicians to make treatment decisions.  You can learn whether your physician is applying the best available therapy.  But, it takes real work (which reduces suffering in the long run).
          Every care manager MUST study the document carefully (and study the last two years of posts on this website).
          The following is a list of NCCN features by page number.  You should study the guide in the following order:
> Pg-4, the new Evidence Block system
> Pg-43, The ranking of chemo regimens using Evidence Blocks.  Focus on the far-left column: Efficacy.
> Pg-46, Staging code.  This coding (and no other), to this detail, should appear in the overall-condition and biopsy reports.
> Pg-47, Details of the disease and therapies.  Note well the Categories of Evidence and Consensus, upper left, Page 47.  Category-1 is, of course, the best.
> Pg 99, Genetic Syndromes and Risk.
> Pg-100, Indications for specific therapies.
> Pg0107, Referenced.  Here you will find treatment leaders AND physicians you may wish to seek for treatment.
> Pg-2, Oncology leaders who authored this guideline.  They are physicians you may wish to consult for treatment.
> Pg-6, Physician decision tree. With the exception of IRE, your physicians should be following this decision tool.

To the detriment of their patients, nearly half of treating physicians ignore these guidelines.  See
http://jaxelection.altervista.org/pancreatic/9_Pancreatic201
http://jaxelection.altervista.org/pancreatic/7_MDAnderson201
         PhilipJax

RE: nanoknife IRE for pancreatic cancer

by Georginamhall on Thu Nov 02, 2017 09:18 PM

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Hi,

Does anyone have thoughts or experience on treatment of metastices in the spine ? My brother was diagnosed in June 2016 with locally advanced PC. Since then he has had nanoknife (Nov 2016), with Folfirinox and then, this year, Abraxane.

Latest scan shows stable tumour around the pancreatic head area (no growth) but progression with two 'new' growths on the  T6 and L4 vertebrae (growing fairly fast).

Hoping to genetically test the tumour he has had ERCP and EUS (Fine Needle) biopsies and they have found only normal cells. 

He was hoping to have nanosomal Irinotecan but specialist says its doesn't look very useful. 

Any information on treatment of spine or thoughts on Third Line possibilities very very appreciated. GH

RE: nanoknife IRE for pancreatic cancer

by Esrph on Thu Nov 02, 2017 10:02 PM

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Having Same issue right now. Put on folfirinox and ca 19 went from 564 to 204after two treatments. Met with John’s hopkins spine radiologist this week and she is going to do Sbrt on the two spots and is very confident she can kill them. May take from 2-5 treatments.

RE: nanoknife IRE for pancreatic cancer

by Georginamhall on Thu Nov 02, 2017 10:10 PM

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Sorry to hear you are in this position but its so good to hear a positive thoughts on treatment. Thank you !! Very best of luck with it .

RE: nanoknife IRE for pancreatic cancer

by GinaGB on Fri Nov 03, 2017 04:01 AM

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On Nov 02, 2017 10:10 PM Georginamhall wrote:

Sorry to hear you are in this position but its so good to hear a positive thoughts on treatment. Thank you !! Very best of luck with it .

Hello: Sorry to hear about your brother. Do you know why the nanoknife didn’t kill the whole tumor? Thanks

RE: nanoknife IRE for pancreatic cancer

by cdaley2 on Fri Nov 03, 2017 10:33 AM

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Esrph

Would you mind my asking a little about JH? Were you always a patient there or did you ask to see them specifically for this treatment. They seem to be more willing to do sbrt and other things on mets than others. I am at MSKCC and love my oncologist, but sometimes they seem a little overly cautious on anything but chemo. Re JH, I don't want to go through their entire process but rather find the right person who specializes in sbrt or whatever for lung mets. Thanks. Chris

RE: nanoknife IRE for pancreatic cancer

by Esrph on Fri Nov 03, 2017 11:35 AM

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Have had Sbrt at hopkins almost three years ago with Dr. Herman, who recently left for MD Anderson. Still go there for all my scans Dr. Narang is Now head of the department. Now going to their spine radiologist Dr. Kristen Redmond. My oncologist is at Georgetown university, but also check with Dr. Zheng at hopkins. Was turned down for nanoknife by Hopkins almost three years ago and went to the University of Louisville. Dr. Robert Martin for nanoknife. Will go wherever feel can help. Good luck and for Sbrt I would definitely call hopkins see who specializes in the area you want . Hope this helps.

RE: nanoknife IRE for pancreatic cancer

by GinaGB on Fri Nov 03, 2017 11:59 AM

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On Nov 03, 2017 10:33 AM cdaley2 wrote:

Esrph

Would you mind my asking a little about JH? Were you always a patient there or did you ask to see them specifically for this treatment. They seem to be more willing to do sbrt and other things on mets than others. I am at MSKCC and love my oncologist, but sometimes they seem a little overly cautious on anything but chemo. Re JH, I don't want to go through their entire process but rather find the right person who specializes in sbrt or whatever for lung mets. Thanks. Chris

Hi I believe we have the same oncologist. I too think she is very conservative even with chemo. Do you know if they even have nanoknife at the mskcc? Thanks

RE: nanoknife IRE for pancreatic cancer

by Esrph on Fri Nov 03, 2017 12:08 PM

Quote | Reply
Oncologist is Dr. Michael Pishvain at Georgetown. Do not believe they have nanoknife at mskcc. I would go to Dr. Robert Martin in Louisville as he has taught most of the others surgeons, even those at hopkins. He is the king of nano.
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