if not personally,

在我的生活圈子中,每個人都有與癌症交手的機會

then through a loved one, a family member,

如果不是個人親身經驗

colleague, friend.

也會因為或是至愛或家庭成員,

And once our lives are touched by cancer,

同事或朋友而與癌症交鋒

we quickly learn

一旦我們的生活被癌症入侵後

that there are basically

我們會很快瞭解

three weapons, or three tools, that are available

目前基本上只有

to fight the disease:

三個武器, 或者說三個工具, 可以

surgery, radiation and chemotherapy.

用來對抗癌症:

And once we get involved

手術, 放射療法及化療

in the therapeutic decisions,

而且一旦我們捲入

again either personally

治療的決策群時,

or with our loved ones and family members,

相同的, 不管是親身體驗

we also very quickly learn

或因至愛或家庭成員

the benefits, the trade-offs and the limitations

我們一樣會很快知道

of these tools.

選擇任何一種治療方法, 有何好處? 有何損失?

I'm very thankful to Jay and to Mark

及其極限。.

and the TEDMED team

我非常感謝杰和馬克

for inviting me today

當然還有TEDMED團隊

to describe a fourth tool, a new tool,

能讓我今天在此

that we call Tumor Treating Fields.

向大家介紹第四種治療癌症的工具--新工具

Tumor Treating Fields

我們稱它為"腫瘤治療電能場"。

were invented by Dr. Yoram Palti,

"腫瘤治療電能場"

professor emeritus at the Technion in Israel.

是尤昂 帕提 博士所發明的

And they use low-intensity

他是以色列理工學院的榮譽教授。

electric fields

是利用低強度

to fight cancer.

的電場

To understand how Tumor Treating Fields work,

來對抗癌症。

we first need to understand

想要瞭解"腫瘤治療電場" 如何運作

what are electric fields.

我們必須要先瞭解

Let me first address

什麼是電場?

a few popular misconceptions.

讓我在此先呈清

First of all, electric fields

幾個大家普遍的誤解

are not an electric current

首先,電場

that is coursing through the tissue.

不是電流

Electric fields

穿越病人組織。

are not ionizing radiation,

電場

like X-rays or proton beams,

不是游離輻射

that bombard tissue

像X 光或質子光束

to disrupt DNA.

會摧毀轟炸病人的組織

And electric fields

來破壞其DNA。

are not magnetism.

電場

What electric fields are

也非利用磁性來作用

are a field of forces.

什麼是電場呢?電場是

And these forces

“帶電粒子”在空間中所建立的“場”。

act on, attract, bodies

是具有“作用力”

that have an electrical charge.

作用, 吸引, 使病人體內

The best way to visualize an electric field

產生電荷。

is to think of gravity.

最好的例子去想像電場是

Gravity is also a field of forces

把它看成重力(地球萬有引力)

that act on masses.

重力也是相互作用的物理場

We can all picture astronauts in space.

只是重力是有關於質量

They float freely in three dimensions

我們可以想像在外太空中的太空人。

without any forces acting on them.

在三度空間中, 他們自由浮動

But as that space shuttle

不須任何力量去推動他們。

returns to Earth,

但是當太空船

and as the astronauts enter the Earth's gravitational field,

回航地球時

they begin to see the effects of gravity.

像太空人進入地球的引力場，

They begin to be attracted towards Earth.

他們開始感受到重力的影響。

And as they land,

他們開始被吸引到地球。

they're fully aligned in the gravitational field.

當他們登陸地球,

We're, of course, all stuck in the Earth's gravitational field right now.

他們就完全被地球引力場所控制。

That's why you're all in your chairs.

當然我們現在都被困在地球的引力場內。

And that's why we have to use our muscle energy

這就是為什麼你們會全坐在椅子上。

to stand up, to walk around

這就是為什麼我們必須使用肌肉的能量

and to lift things.

才能站起來，走動

In cancer,

和舉起任何東西。

cells rapidly divide

對癌症而言，

and lead to uncontrolled tumor growth.

細胞迅速分裂

We can think of a cell

最後導致腫瘤生長快速失控。

from an electrical perspective

讓我們想像一個細胞

as if it's a mini space station.

從電氣角度的眼光來看

And in that space station

彷彿是一個小型的太空站。

we have the genetic material, the chromosomes,

在那個太空站中

within a nucleus.

有我們的遺傳物質，染色體，

And out in the cytoplasmic soup

存在一個細胞核內

we have special proteins

外層的細胞質湯包中

that are required for cell division

有些特殊的蛋白質

that float freely in this soup

是細胞分裂時所需要的

in three dimensions.

這些蛋白質在此湯中

Importantly, those special proteins

向四面八方自由浮動

are among the most highly charged objects

重要的是，這些特殊的蛋白質

in our body.

是極易帶電荷的物質之一

As cell division begins

在我們體內

the nucleus disintegrates,

當細胞開始分裂

the chromosomes line up

細胞核解體，

in the middle of the cell

在這細胞的正中間

and those special proteins

染色體排起隊

undergo a three-dimensional sequence

這些特殊的蛋白質

whereby they attach

進行三度空間排列

and they literally click into place end-on-end

在那兒它們附上

to form chains.

然後文字上來說終端與終端點擊連結

These chains

形成許多鍊條。

then progress and attach

這些鍊條

to the genetic material

然後進化並連接上

and pull the genetic material

遺傳物質上

from one cell into two cells.

然後拉扯著遺傳物質

And this is exactly how

最後從一個細胞分裂成兩個細胞。

one cancer cell becomes two cancer cells,

這正是為什麼

two cancer cells become four cancer cells,

一個癌症細胞會變成兩個癌細胞，

and we have ultimately

兩個癌細胞,成為四個癌細胞，

uncontrolled tumor growth.

然後最終

Tumor Treating Fields

腫瘤生長失控。

use externally placed transducers

"腫瘤治療電場"

attached to a field generator

使用體外傳感器

to create an artificial electric field

連接到電場發電機

on that space station.

創建一個人工電場

And when that cellular space station

在那個"太空站"上。

is within the electric field,

所以當細胞"太空站"

it acts on those highly charged proteins

籠罩在電場中，

and aligns them.

就會活化這些極易帶電荷的蛋白質

And it prevents them from forming those chains,

控制它們

those mitotic spindles,

並阻止他們形成鏈條，

that are necessary to pull the genetic material

所謂的"有絲分裂紡錘體"

into the daughter cells.

這是把遺傳物質拉進

What we see is that the cells will attempt to divide

兩個子細胞所須要的蛋白質。

for several hours.

這裡可看到的是，細胞會試圖分裂

And they will either enter into

歷經好幾個小時。

this so-called cellular suicide,

這些細胞不是將進入

programmed cell death,

所謂的細胞自殺狀態，

or they will form unhealthy daughter cells

是細胞自殺的機制系統，

and enter into apoptosis

不然就形成不健康的子細胞

once they have divided.

使細胞早衰進而死亡

And we can observe this.

這是如果他們有分裂成功的結果。

What I'm going to show you next

我們可以觀察到這一點。

are two in vitro experiments.

接下去我要告訴你們的是

This is cultures, identical cultures,

我們的兩個體外實驗。

of cervical cancer cells.

這是培養皿 ,在一模一樣條件下,

And we've stained these cultures

培養子宮頸癌細胞。

with a green florescent dye

我們將

so that we can look at these proteins

讓它們帶有綠色螢光染料

that form these chains.

這樣我們就可以看見這些蛋白質

The first clip shows

形成鏈條，

a normal cell division

第一個剪輯顯示

without the Tumor Treating Fields.

一個正常的細胞分裂

What we see

未受"腫瘤治療電場"影響。

are, first of all, a very active culture,

首先，我們可看到

a lot of divisions,

這個培養皿裡的

and then very clear nuclei

細胞分裂非常活躍，

once the cells have separated.

當細胞分裂完成後

And we can see them dividing throughout.

可看到很清楚的細胞核。

When we apply the fields --

我們可以看到他們分裂的整個過程。

again, in the identical time-scale

當我們應用"腫瘤治療電場" -

to the identical culture --

在相同長度的記錄時間內

you're going to see something different.

來觀察生長條件相同的對照組

The cells round up for division,

你們就會看到不同的結果。

but they're very static in that position.

這些細胞想要打起精神分裂成長,

We'll see two cells

但事實上他們卻在那裡沒有進展。

in the upper part of the screen

這是兩個細胞

attempting to divide.

在屏幕的上部

The one within the circle manages.

企圖分裂。

But see how much of the protein

在圓圈內的那個。

is still throughout the nucleus,

但, 看!有多少的蛋白質

even in the dividing cell.

仍然貫穿圍繞細胞核，

The one up there can't divide at all.

甚至在細胞分裂時。

And then this bubbling, this membrane bubbling,

那個在上方位置的根本無法分裂

is the hallmark

然後接著冒泡，細胞膜起泡，

of apoptosis in this cell.

就是一個標誌

Formation of healthy mitotic spindles

是此細胞將凋亡的特徵。

is necessary for division

健康的有絲分裂紡錘體的形成

in all cell types.

是細胞分裂繁殖必要的

We've applied Tumor Treating Fields

每一種細胞都是如此

to over 20 different cancers in the lab,

我們已經應用"腫瘤治療電場"

and we see this effect

在實驗室中, 應用於超過20種不同的癌症，

in all of them.

我們想確認它對各種不同癌症

Now importantly,

的效果

these Tumor Treating Fields have no effect

重要的是，現在我們已確認

on normal undividing cells.

"腫瘤治療電場" 對正常未分裂的細胞

10 years ago,

沒有干擾效果。

Dr. Palti founded a company called Novocure

10年前，

to develop his discovery

帕提博士創辦Novocure公司

into a practical therapy for patients.

以推展他的發現

In that time, Novocure's developed two systems --

使其能應用到病人的實際治療。

one system for cancers in the head

在那個時候，Novocure 開發兩個系統 -

and another system for cancers in the trunk of the body.

一個系統是針對於頭部癌症

The first cancer that we have focused on

另一個系統是對身體軀幹內的癌症。

is the deadly brain cancer, GBM.

我們首先把重點放在GBM(多發性多形性膠質母細胞瘤) ，

GBM affects about 10,000 people

這是一種致命的腦癌。

in the U.S. each year.

在美國每年

It's a death sentence.

約10,000人得到GBM。

The expected five year survival

對病人而言, 這是死亡宣判書。

is less than five percent.

預期可以有5年存活率的病人

And the typical patient

低於百分之五。

with optimal therapy

而對大多數的GBM病人而言

survives just a little over a year,

即使使用最佳的治療方法

and only about seven months

存活的時間只是略超過一年，

from the time that the cancer is first treated

通常在第一次療程完成後

and then comes back and starts growing again.

大約7個月後，

Novocure conducted

癌症會復發, 並開始再次增長。

its first phase three randomized trial

Novocure進行

in patients with recurrent GBM.

其第一階段的三個隨機試驗

So these are patients

所有的病人全是GBM復發者。

who had received surgery,

這些患者

high dose radiation to the head

都曾接受手術治療，

and first-line chemotherapy,

接受頭部高劑量輻射的療程

and that had failed and their tumors had grown back.

和採取過第一線化療，

We divided the patients into two groups.

全失敗，他們的腫瘤全長回來。

The first group received second-line chemotherapy,

我們把每次實驗的病人分兩組

which is expected to double the life expectancy,

第一組接受第二線化療，

versus no treatment at all.

估計可將比不給予治療時預期壽命

And then the second group

延長一倍的時間。

received only Tumor Treating Field therapy.

然後第二組

What we saw in that trial

不給第二線化療藥物,只接受"腫瘤治療電場"

is that that the life expectancies of both groups --

我們看到該試驗的結果是

so the chemotherapy treated group

這兩組病患的預期存活壽命 -

and the Tumor Treating Field group --

接受第二線化療藥物的化療組

was the same.

和只接受"腫瘤治療電場"的這組病患

But importantly,

存活時間一樣

the Tumor Treating Field group

但重要的是，

suffered none of the side effects

只接受"腫瘤治療電場"的這組病患

typical of chemotherapy patients.

無遭受任何

They had no pain,

化療病人通常會有的副作用

suffered none of the infections.

他們沒有痛苦，

They had no nausea, diarrhea,

沒有遭受感染的高風險。

constipation, fatigue

他們有沒有噁心，腹瀉，

that would be expected.

便秘，疲勞

Based on this trial,

這些都是化療可能的副作用。

in April of this year,

根據這項試驗，

the FDA approved Tumor Treating Fields

在今年4月，

for the treatment of patients

美國食品衛生局(FDA)批准"腫瘤治療電場"

with recurrent GBM.

可被使用在

Importantly, it was the first time ever

再復發型的GBM病患

that the FDA included

重要的是，這是有史以來第一次

in their approval of an oncology treatment

FDA批准加註

a quality of life claim.

這種的腫瘤治療方法

So I'm going to show you now

提升了病人的生活品質。

one of the patients

我現在要告訴你們

from this trial.

一個我們臨床試驗

Robert Dill-Bundi

病人的故事

is a famous Swiss cycling champion.

羅伯特·迪爾，邦地

He won the gold medal in Moscow

一個著名的瑞士自行車賽冠軍。

in the 4,000 meter pursuit.

曾在莫斯科

And five years ago,

4000米的競賽贏得金牌

Robert was diagnosed with GBM.

五年前，

He received the standard treatments.

羅伯特被確診得GBM。

He received surgery.

他接收標準療法。

He received high dose radiation to the head.

接受了手術。

And he received first-line chemotherapy.

他接受了頭部高劑量輻射的治療。

A year after this treatment --

他也接收第一線化療。

in fact, this is his baseline MRI.

接受治療後的一年 -

You can see that the black regions

這是他的基礎核磁共振I。

in the upper right quadrant

可以看到這黑色區域

are the areas where he had surgery.

在右上角四分之一區

And a year after that treatment,

在那地方,他做了手術。

his tumor grew back with a vengeance.

然而,治療後的一年，

That cloudy white mass that you see

他的腫瘤瘋狂生長回來。

is the recurrence of the tumor.

你所看到那大塊多雲的白色區

At this point, he was told by his doctors

就是復發的腫瘤。

that he had about 3 months to live.

在這種形狀下，他的醫生告訴他

He entered our trial.

他的壽命大概只有3個月左右。

And here we can see him getting the therapy.

他加入了我們的臨床實驗

First of all, these electrodes are noninvasive.

這就是他所得到的治療。

They're attached to the skin

首先，這些電極並無侵入性。

in the area of the tumor.

它們附著在皮膚上

Here you can see

在腫瘤領域裡。

that a technician is placing them on there much like bandages.

從這裡你可見到

The patients learn to do this themselves

技術員把電極放置在那裡，很像繃帶。

And then the patients

病人很快就學習自己來

can undergo all the activities of their daily life.

然後病人

There's none of the tiredness.

可以進行他們日常生活的所有活動。

There's none of what is called the "chemo head."

不再容易疲勞。

There's no sensation.

沒有什麼所謂的“化療頭。”

It doesn't interfere

不再有強烈的反應。

with computers or electrical equipment.

它不會受電腦

And the therapy is delivered continuously

或電器設備干擾。

at home,

病人可不間斷治療

without having to go into the hospital

即使是在家中

either periodically or continually.

並無需定期

These are Robert's MRIs,

或不斷進入醫院。

again, under only TTField treatment.

這些羅伯特的核磁共振圖，

This is a therapy that takes time to work.

只有用"腫瘤治療電場"來治療

It's a medical device;

這是個需要長時間的治療。

it works when it's on.

這是一個醫療儀器;