nanoknife IRE for pancreatic cancer

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RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Mon Feb 22, 2021 01:05 PM

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NCCN 1.2021 Guidelines
How to Study the Guidelines

          The new 1.2021 NCCN guidelines are now available, released in December 2020.  The new guidelines can be downloaded here: /downloads/NCCN1.2021Pancreatic.pdf" target="_blank" rel="nofollow"> /downloads/NCCN1.2021Pancrea

How to Use the NCCN Guidelines
          NCCN guidelines are used by medical oncologists to make treatment decisions.  However, more than half of all treating physicians ignore these guidelines.  Read about the detrimental consequences to patients here:
          The NCCN guidelines (link above) will allow you to determine whether your physician is applying the best available therapy.  It takes a few days of real work to study them, but they reduce 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-37: The ranking of chemo regimens for Adjuvant Therapy (follows surgery) using Evidence Blocks.  Focus on the far-left column of each block, titled: Efficacy.
>>> Pg-39: Evidence Blocks for Locally Advanced disease.
>>> Pg-41: Evidence Blocks for Metastatic disease.
>>> Pg-45: Evidence Blocks for subsequent therapy.
>>> Pg-56: Staging code.  Coding to this detail should appear in the patient’s overall-condition and biopsy reports.
>>> Pg-58: Discussion of the disease and therapies.  And, note well, Pg-57, the Categories of Evidence and Consensus.  Using this code the authors rank the reliability of therapies, with Category-1 being the most reliable.
>>> Pg 111: Genetic Syndromes and Risk.
>>> Pg-112: Indications for Various Therapies.
>>> Pg 114 Graphics of surgical sections.
>>> Pg-119: References.  Here you will find research 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.  Your physicians should be following this decision tool.  However, omitted is Irreversible Electroporation (IRE), which is an important process for improving surgical margins and managing tumor-encased blood vessels and ducts.  IRE are found by studying the website: /" target="_blank" rel="nofollow"> /
          Be sure to study the continuously updated Decision Guide, PJaxDecisionAlgorithm.pdf , which offers guidance on all pancreatic cancer topics, including the latest therapy, care management and clinical trials. /downloads/PJaxDecisionAlgorithm.pdf " target="_blank" rel="nofollow"> /downloads/PJaxDecisionAlgor

Footnote.  The NCCN panel is outdated in recommending against IRE for locally advanced disease “due to concerns about complications and technical expertise.”  You will note that from page-59 and thereafter, the text is dated by several years and is being updated.
          NCCN bases its old, incomplete IRE recommendation on the 2016 musings of several non-IRE practitioners – statements selectively chosen by freelance writer Susan Jenks.  Those physicians never address IRE’s unique applications: Improving surgical margins and removing tumors which encase blood vessels and ducts, thus making Margin-Negative surgical resection (and cure) possible.
          NCCN’s earlier, unfounded concern about “complications” is based on the first 10 IRE patients at the inexperienced Roswell Park Cancer Institute.  In 2016 Roswell’s Steven Hochwald pondered “What’s unclear is whether IRE really makes a difference in patient outcomes.” 
          Now, two years and only 15 patients later, a still-inexperienced Roswell Park values IRE differently, insisting: “We have had some success in extending survival using IRE.”  To date, NCCN has not made the Roswell correction, because that entire document section is being updated, but not yet published.  See the 2018 Roswell statement here:
          Of course, IRE should be performed by the nation’s leading IRE practitioners, identified at the website.
          NCCN no doubt will change its recommendation in the upcoming revision, and will not allow politics to overrule good medicine.
          And the poorly-researched 2-page 2016 interview, which unreasonably nixed a favorable IRE recommendation, is downloadable here:



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