While surgery, radiation and chemotherapy may be the first cancer treatments that come to mind, interventional oncology has become an essential component of the multidisciplinary team approach to cancer care.
Procedures in interventional oncology, a subspecialty of interventional radiology, use minimally invasive techniques, in combination with image guidance, to precisely target cancerous tumors, according to Govindarajan Narayanan, M.D., chief of interventional oncology at Miami Cancer Institute. 
“I’m an interventional radiologist at the Miami Cardiac & Vascular Institute  (MCVI), that’s where I perform all my procedures, but I also have an appointment with Miami Cancer Institute  as the chief of interventional oncology,” said Dr. Narayanan. “Being able to have this dual appointment presents a very unique opportunity to bring interventional oncology in a more expanded version into MCVI and Baptist Health South Florida.”
(Watch now: The Baptist Health News Team hears from Govindarajan Narayanan, M.D., and Ripal Gandhi, M.D., both interventional radiologists at Miami Cancer Institute and Miami Cardiac & Vascular Institute, about irreversible electroporation (IRE) or NanoKnife. Video by Carol Higgins.)
Dr. Narayanan is well known as a pioneer in this field, developing new techniques and researching innovative applications of technologies, including irreversible electroporation (IRE) or NanoKnife.
Unlike other ablation methods which use extreme heat or cold to kill tumor cells, NanoKnife uses electrical currents to destroy soft-tissue tumors. Using CT imaging to guide them, interventional radiologists insert needles into the patient’s body through tiny incisions to precisely position them around the tumor. Powerful pulses of electrical current are then sent between the needles and holes are punched into the walls of the tumor cells resulting in cell death. This procedure leaves surrounding tissue, veins and nerves unaffected. This “electrocution” method can offer advantages over thermal ablation techniques which cause a heat-sink effect that can be damaging to critical structures near the tumor.
“Most of these procedures are done as outpatient procedures,” said Ripal Gandhi, M.D., an interventional radiologist at Miami Cancer Institute  and Miami Cardiac & Vascular Institute . “For some of the larger procedures, patients will stay overnight and go home the next day. Most the time it’s very well tolerated with very minimal pain or minimal complications.”
Dr. Gandhi explains that individual patients’ treatment plans are determined by a multidisciplinary team consisting of surgical, medical, radiation and interventional oncologists.
“I think Miami Cancer Institute is very unique in that it provides all treatment options for cancer under one roof and we all get together in a multidisciplinary tumor board where all patients and all treatment options are discussed.”
Dr. Gandhi adds: “Nanoknife now gives us the full complement of interventional oncology therapeutic procedures, so this is one of few centers in the entire country where we pretty much have every single modality available to treat patients with cancer from an interventional oncology perspective.”
Today, NanoKnife therapy is primarily used for liver, kidney and gall bladder tumors. In early 2018, the U.S. Food and Drug Administration (FDA) granted an accelerated path for this technology to be studied in pancreatic cancer, an area of special interest to Dr. Narayanan, who has been researching it for 9 years. “Based on all the data that has been published by me and other clinicians involved in this field, we believe that there is a clear signal that it’s something that needs to be studied further. We think there’s a lot of promise for NanoKnife’s role in pancreatic cancer.”
The Baptist Health News Team shadowed Dr. Narayanan and Dr. Gandhi during a recent NanoKnife procedure. Watch the video now.