Each year, 230,000 people are diagnosed with breast cancer. One in six of those will die. But if detected early, a new treatment from Sweden could have patients in and out of the hospital and cancer-free on their lunch break.
For 17 years, Gunilla Pilo enjoyed a challenging career planning dinners for the nobel prize held each year at city hall in Stockholm, Sweden.
But after retiring last year, she faced a bigger challenge. Doctors found a cancerous tumor in her breast.
"It was a shock," Gunilla said.
She enrolled in a research study on a new technique to kill breast tumors -- known as preferential radio frequency ablation or PRFA -- the brain child of Professor Hans Wiksell.
"As soon as you have done, it you can say to the patient that now the tumor cannot spread anymore," said Wiksell, who teaches at Karolinska Institute, Sweden.
The goal is to catch it at an early stage.
"Those women, if we can get them to go through minimally invasive therapy instead of surgery, it will help them a lot," said Dr. Karin Leifland, mammography physician and head of the Unilabs Mammography Department at Capio St. Göran´S Hospital in Stockholm.
Doctors place a thin electrode guided by ultrasound into the tumor. The tumor is then heated to 167- degrees , killing it and leaving the surrounding tissue unharmed.
"The DNA and other things inside dies, so it could not live anymore, it could not divide anymore," Wiksell explained.
The non-invasive surgery can be done in an hour, with no scars and no recovery time.
"You could do it at your lunch time and then go back and work afterwards. You don't really feel anything," said Gunilla.
Because of PRFA, Gunilla is now cancer-free and enjoying the beauty around her.
Researchers at Karolinska University and St. Goran Hospital in Sweden are continuing their study of PRFA with elderly women who, because of their age, are often not fit for surgery. So far, the PRFA technique has worked 100-percent of the time for this population.
RESEARCH SUMMARY
BACKGROUND: Breast cancer occurs when some breast cells begin growing abnormally. These cells divide more rapidly than healthy cells, accumulating to form a tumor that may spread through your breast, to your lymph nodes or to other parts of your body. There are numerous types of breast cancer, but cancer that begins in the milk ducts (ductal carcinoma) is the most common type. Breast cancer can occur in both men and women, but it's far more common in women. After skin cancer, it is the most common cancer diagnosed in women in the United States. Doctors determine breast cancer treatment options based on the type of breast cancer, its stage, whether the cancer cells are sensitive to hormones, overall health, and personal preferences. Most women undergo surgery for breast cancer and also receive additional treatment such as chemotherapy, hormone therapy or radiation. (SOURCE: Mayo Clinic)
CAUSES: It's not clear what causes breast cancer. Doctors estimate that only five to 10 percent of breast cancers are linked to gene mutations passed through generations of a family. It's likely that breast cancer is caused by a complex interaction of genetic makeup and environment. (SOURCE: Mayo Clinic)
RISK FACTORS: Factors that are associated with an increased risk of breast cancer include: being female; increasing age; a personal history of breast cancer; a family history of breast cancer; inherited gene mutations that increase the risk of cancer; radiation exposure; obesity; beginning your period at a younger age (before 12); beginning menopause at an older age (after 55); having your first child at an older age (after 35); postmenopausal hormone therapy; and drinking alcohol. (SOURCE: Mayo Clinic)
TREATMENT: There are six standard treatments currently used for breast cancer including surgery, sentinel lymph node biopsy, radiation therapy, chemotherapy, hormone therapy, and targeted therapy. Patients may decide to participate in clinical trials for treatment. There are thousands of ongoing clinical trials for breast cancer, including PRFA. The first clinical trial for PRFA has been published, and a second is ongoing. The current focus of this clinical trial is on elderly patients, but there are plans to expand the trials to include those with benign changes. (SOURCE: Mayo Clinic, www.karolinskadevelopment.com)
INTERVIEW
Hans Wiksell, Professor of Medical Technology, Karolinska Institutet, Sweden, talks about a new treatment for breast cancer.
You developed the anti-seeding needle, this is something you're very passionate about. Can you talk about that, how it came to be?
Dr. Hans Wiksell: Well, I think it's wrong basically to separate therapy and diagnostic procedures because it is possible to start a therapy already from the very first diagnostic procedure you do. If you look at our technique to treat tumors anti-seeding is very similar but much smaller. Anti-seeding is a new idea in a way that no one knows how big the risk is. Seeding tumor cells can be disseminated by the needle action and then go by blood and lymphatic streams to other parts in the body, especially when the tumor is newly detected and still very small. Nobody really knows how big that risk is compared to the natural way tumor cells spread.
Even though we do not know exactly what the risk is you wanted to eliminate risk?
Dr. Hans Wiksell: Exactly, that is very correct. And made as early as possible.
You started the anti-seeding with brain tumors?
Dr. Hans Wiksell: We started many years ago with brain tumors, that was not anti-seeding, that was to heat the tumor in order to kill it really. The results were excellent already at that time, but the brain is a difficult site. It's a very difficult site. Therefore, I was starting to think about other targets and then I thought that the breast is a perfect target. I tried to start an activity based on that.
What is it that makes the breast an easier site than the brain?
Dr. Hans Wiksell: It's not very important if you take a little too much. I think it's important in the beginning at least to heat a little bit too much of the tissue in order to make sure that you don't have a problem when you analyze the results, it should be radical. You must be sure the tumor is completely deactivated or dead. The breast is not so important in a way, the organ is localized in a very nice way so you can move it. It's in fact perfect in all ways. If you take a little little too much it's not so important. When the temperature elevates - like what I call a non-stationary phase - then the power is very high in order to reach the therapeutic level of temperature very quickly so we can say now the treatmens have started, increased temperatures are stable. After that, the temperature is stationary; we try to just keep it at that level for ten minutes. During that, we can see that the power first increases because the blood perfusion-cooling (blood circulation cooling) increases, the flow increases, body defend itself against the heating, later we coagulate the tissue and that means the power needed to keep the temperature stationary goes down and I can look at that. Now; we also have to measure the temperature and it's important to know that we put an electrode through the breast, through the tumor. The surface temperature of this electrode should not be too high, the heat is developed in the tissue itself not in the electrode or the needle. Still we need to cool this electrode because if the surface temperature went to high there would be a lot of small bubbles and they ruin the treatment, because electricity cannot go through air or vapor, which is insulating, gases. The fact that we call it an electrode means also that the Temperature sensor that is used for the electrode cannot measure the absolute temperature very accurately. It's like your measuring the temperature outside from the inside of the window. Therefore we have developed a special technique that can compensate for the cooling-deviation or bias, and give us the correct temperature inside the tumor. We call this a correct temperature measurement. This works very well. Now, the thing that is very important where we have skilled competence and assistance from our mammographic department, essential part our team, is that it is extremely important to place the electrode correct before you start the treatment. That can be a tricky thing if the tumor is fibrous or hard, if when you put the needle in, the tumor goes away. We have developed a new technique. It's a small micro-mechanical vibration, it is called "Fourier based technique", that we feed through the needle, meaning that you can put the needle precisely in a very small tumor without risking that the tumor moves away by using inertia-forces to stabilize the tumor structures. We know from the beginning that the electrode is localized in the tumor with very high precision and tactically well. This is extremely important for a good result, which we have.
First you use the heat?
Dr. Hans Wiksell: First, after the local anesthesia is injected just like at the dentist, we have to introduce the needle-shaped electrode by a diagnostic radiologist using real time ultrasound as guidance. That is the most important step, we have to introduce the needle in the center of the tumor. It's a delicate procedure, which could be very difficult if it's a hard and small tumor. Then, today, we heat for ten minutes. You can divide the heating in the start-up phase and stationary treatment phase.
What happens to it?
Dr. Hans Wiksell: Internal biological structures melt, possibility to divide cannot work anymore, and it becomes harmless.
It just melts and is absorbed through the body?
Dr. Hans Wiksell: Fine structures inside will be ruined, so it could not live anymore, it could not divide anymore and that's our goal. But you shouldn't burn it, that will cause a lot of other unwanted reactions, gas formation etc., and will cause mechanical problems too, like adjacent tissues will loss elasticity. So you shouldn't go to high. You should not cause vapor to produce, that will cause miniature explosions inside. Never boil, the temperature should be seventy degrees, maybe eighty, not more.
What is that in Fahrenheit?
Dr. Hans Wiksell: I don't know. Seventy degrees Celsius is our goal temperature.
So basically you want to heat it away, correct?
Dr. Hans Wiksell: We kill it. The tumor ideally should look the same after it's killed as it did before we started. That's very important, otherwise it would start to move inside and change shape during treatment, we have from the beginning localized the electrode very correctly, it's not good if it moves by growing or shrinking. Everything should be well figured out in each detail.
When you kill it, do you remove the tumor?
Dr. Hans Wiksell: No, due to ethical things, we do remove it after some time but we will probably stop that. The good thing is that as soon as you have treated the tumor it cannot spread anymore even when mechanically excited. Patients who die, do not die due to the primary tumor, they die due to spread of metastasis in other organs. That is what we first of all like to prevent.
Why are you so passionate about this?
Dr. Hans Wiksell: I'm very interested in electronics and for about twenty years, I have been very interested in Medical Science. Maybe, because I had a problem when I was young, I read everything I could like pharmaceutical specialty books. It made me very interested in medical things.
What did you have when you were very young?
Dr. Hans Wiksell: Asthma, I am free from that now.
Did you treat yourself?
Dr. Hans Wiksell: In a way, what I did actually was, I did not treat it too much, correct drugs are important, and I had pet animals.
Is there anything else you would like to mention?
Dr. Hans Wiksell: I think the most important thing here to have the success with cancer treatment is that the earlier you can treat it, the more success you will have. You should do it very quickly as soon as you know that it is a cancer tumor. You should try to destroy it, and that is the good thing with this procedure, you can do it very quickly. As soon as you have done it, you can say to the patient that now the tumor itself cannot spread anymore.
If a person comes in for a checkup, you would actually diagnosis and kill the tumor that day?
Dr. Hans Wiksell: That's my goal, but I think these are things you should discuss with my associates and with our team. We have decided that the tumor should not be bigger than 20 millimeters, about one inch a little smaller than one inch. You have to diagnose it first. You must know exactly what kind of cancer it is to decide the postoperative treatment plan afterwards, even though the tumor is dead. Just like what you do when you have had surgery. So we have to take a diagnosis, we have to know what it is, and then when we know that exactly we will proceed. It's very important that we - our team - can handle medical, electronic, computer, mechanical, and many other questions. That is the key to our success.
What is the difference in your procedure versus the previous methods used in burning tumors away?
Dr. Hans Wiksell: The difference is, we call this preferential radio frequency ablation (PRFA), earlier we had only radio frequency ablation. The difference is that we have a more non sensitive delivery, the impedance is very low and the frequency we use for heating is low. Meaning that effect of reactance's is small or absent.
What is reactance?
Dr. Hans Wiksell: It's an electronic term, which means if you let electric current go through a capacitor, and then the phase angle between voltage and current will become different from zero, not parallel in time. That is not good because the power you have is partly reactive. But you need active power for heating. The interesting thing with most of this earlier work, they used equipment that was designed for other purposes than the heating. They borrowed it from something. What we have done is made it for this very specific purpose and nothing else. The properties are adjusted to get the result we desire. The computer control is important. We know when procedure is ready with the correct dosage of power versus time. It is a qualitative temperature control. They started with hyperthermia treatment in the United States in the 1950's and 1960's. The result was often not very good, often they did not have the correct temperature all over. It's difficult to know what you're doing. Also the electrode placement is of course extremely important for outcome, where we have Excellence by our radiology personal and the new Fourier-technique.
If we go with a lot of heat, how does it work with so little electrical power?
Dr. Hans Wiksell: We use an electrode that fits the size of the tumor, because the size of the electrode is important for the size of the heat pattern. And we control power well.
Basically, you are using this heat to protect the surrounding tissue?
Dr. Hans Wiksell: Heat is a very lenient and efficient way to kill everything that lives. The only thing you need to do is control the heat and the propagation of heat with high precision and that's quite difficult but it is fantastic way to kill tumors and prevent spread.
You are very specific in the targeted area that you are placing the heat and keeping it at the correct temperature?
Dr. Hans Wiksell: Like I said in the beginning, the most important work is that of the radiologist to put that electrode in the correct position. It calls for a lot of skill and we have developed the new method that assists.
The method that was used with higher heat, was it not as precise as your method?
Dr. Hans Wiksell: It's difficult for me to talk about others, I do not know that.
FOR MORE INFORMATION, PLEASE CONTACT:
Karin Leifland, M.D., Ph.D.
Capio S:t Göran´s Hospital in Stockholm
Karin.Leifland@unilabs.com
http://www.unilabs.com
