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While most of us "consider cancer as a problem of modern technical society... almost 70 percent of all cancers occur in economically undeveloped countries," says Prof. Boris Rubinsky by way of introduction to one of his center's most important achievements - finding a way to destroy cancerous tumors in individuals in remote locations, using what looks a lot like a pair of knitting needles.
"We think that cancer is our problem, but cancer is really the problem of the economically disadvantaged parts of the world, and will become worse," with nine million deaths expected in 2015 and 11.4 million by 2040, he says. While more than 60% in industrialized nations get treatment, a high percentage of patients in developing countries, even those with potentially curable cancer, receive inadequate or no therapy, he says. In addition, in places where treatment is available, it is often difficult, expensive and often just doesn't happen.
"Our idea was to develop a technology that is inexpensive and more effective than any other for treatment of solid tumors and palliation," for allowing the patient to live decently and without pain before he or she dies, he says.
Relying on the beginnings of cryosurgery and minimal-invasive surgery he was involved with developing in the 1980s - in which a needle was perfused with liquid nitrogen, introduced into the tumor and then the tumor was destroyed by freezing - Rubinsky added his knowledge of medical imaging and, while working with colleague Gary Onik, came up with an idea. "It occurred to us that if we combined imaging with this process of cryosurgery, the surgeon could actually see in real time how much he freezes. And that completely changed the whole perspective of minimal-invasive surgery," he explains.
Among those treated this way was South Africa's Bishop Desmond Tutu and, as it turned out, the father of the driver of a cab Rubinsky happened to get into in Toronto. It is the only FDA-approved treatment of prostate cancer where radiation has failed. "There are tens of thousands of people around the world who are being treated with this technique. So I can categorically say that imagining-monitored cryosurgery and all its branches were invented by me and Gary," Rubinsky says proudly.
Then in early 2000, that discovery led to non-thermal, irreversible electroporation, a "new minimally invasive surgery that could be used in disadvantaged parts of the world," he explains.
In work he'd done in Antarctica on salmon, he introduced genetic material into the fish via an electronic chip - which became known as the bionic chip and which was made famous on The Discovery Channel - and then used electrical pulses to open nanoscale pores in the cell membrane to introduce the required gene into the fish's relevant cells.
"This led me to thinking about using electrical pulses to affect the cell membrane," says Rubinsky. He discovered "certain sequences of electrical fields that produce nanoscale pores in the cell membrane which then do not close anymore and lead to cell death," offering a new modality for destroying any kinds of cells, including cancerous ones.
"Once you reach this domain of electrical fields, you reach a way of treating cancer which is very simple. Because all you need are two needles with electrodes which you insert around the tumor in the body. Pulses passed between the needles are only a microsecond to a millisecond long, and if you design them correctly, this cancerous tissue is killed in such a way that just the cell membrane dies. Then you take the needles out... and the immune system removes the destroyed cells."
All one really needs to run the system is a car battery, says Rubinsky, "which provides the power you need to discharge an electrical pulse through the electrodes to the tissue. So right now we have assembled a whole package to allow us to treat cancer in places where otherwise it would not have been able to be treated."
Sloan-Kettering in New York is among 20 or more world cancer treatment centers working with this system. "So I can say that this system is being tried out all over the world for lung cancer, pancreatic cancer, brain cancer - the kinds of cancer that were not treated in the past anywhere else. And we are working on ways to transfer it to parts of the world in which there was no treatment for palliative needs, for instance, Vietnam and Rwanda, and it's a tremendous feeling." -
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