This Targeted therapy works through electrical probes. Since May 2022, Chartres hospital (Eure-et-Loir) has been using this focal treatment by electroporation, which is part of a major study at the national level.
The Chartrain establishment is one of fourteen French university hospitals and clinics to take part. Doctor Luca Lunelli joined the Chartres hospitals at the end of 2019. A specialist in urological oncology with a focus on prostate, kidney and bladder cancer, he has developed an integrated course of multiparametric MRI and targeted biopsies. “We are targeting the prostate tumor. Images are merged between those of the MRI, prior to the operation, and the ultrasound image obtained at the start of the operation. »
This allows the specialist great precision in the positioning of his electrodes, also called probes or needles, which are the source of energy that will treat the lesions. In total, the 71-year-old patient operated on that day will have spent 45 minutes in the operating room, including 30 minutes of installation and only 8 to 10 minutes of treatment.
Advantage: avoid or postpone more radical treatment
Luca Lunelli is one of the first surgeons in France and in Europe to have practiced this technique of electroporation. It was in 2015 at the Tenon hospital in Paris. “This type of focal treatment preserves the entire prostate. Pores are created through the delivery of high intensity electrical pulses. This electricity does not cause a thermal effect and therefore preserves the tissues, muscles and other nerves which are not the subject of the treatment”, details the professional of Italian origin before the operation.
Another advantage of this technique: it makes it possible to avoid or postpone a more radical treatment, such as a total prostatectomy or radiotherapy, without preventing it from being used later if necessary. Electroporation also preserves the erection nerves and there is no effect on urinary continence either.
no scar
The technique, which can be repeated, is semi-invasive and does not cause a scar. “We do not open the body surface but we pass through the skin, at the level of the perineum, with needles”, he continues. The American-designed generator, costing 300,000 euros, delivers 3,000 volts.
By superimposing the MRI images, the surgeon knows exactly where the cancerous tumor(s) are located. The surgeon then places a box on the patient, a kind of identification grid, where he then plants the long needles that will send the electric current. One hundred electric shocks will be sent to eliminate the diseased cells, ie for the septuagenarian lying on the table, six minutes of treatment. “Electroporation can also be used to treat cancer of the liver or of the pancreas and the kidney”, specifies the 40-year-old doctor.
In the operating room, the doctor is assisted by François-Xavier Curnier, an employee of the American company Angiodynamics, which markets the generator. “We are going to induce the natural phenomenon called apoptosis thanks to electrical impulses. This will trigger the death of diseased cells. Generally, the patient goes home the next day. He will have to undergo a consultation three months later and an MRI as well as a biopsy one year after the operation.
A highly regulated framework
Currently, this niche cancer treatment can only be offered within the highly regulated framework of a national study, called IRM PROFT, coordinated by the Parisian hospital of La Pitié-Salpêtrière, in which Chartres participates. The course is therefore very precise and the protocol strict. “This technique makes it possible to treat a cancer of low to intermediate aggressiveness”, emphasizes the surgeon.
Thirty patients have already been treated by electroporation in France. The study plans to treat 250 more over the next two years. They are six in Chartres to have been operated. “About twenty patients should benefit from this technique by the end of the study”, specifies the practitioner, who has recorded around 150 operations of this type to his credit.
“It’s a major asset for the hospital to have a young person doing research,” rejoices Marie-Esther de Tinguy, head of the urology department. “It is also important to have state-of-the-art equipment and to be supported in our projects. »
–
