Pulsed Electric Field Therapy Offers Advantages in Advanced Lung Cancer

In a significant advancement for thoracic oncology within the Appalachian region, WVU Medicine has announced it is the first health care system in West Virginia to utilize pulsed electric field (PEF) therapy for the treatment of metastatic lung nodules. This innovative approach, led by the specialists at the WVU Heart and Vascular Institute (HVI), offers a new line of defense for patients facing advanced malignancies that have traditionally been difficult to manage once standard systemic therapies reach their limits.¹

Saiesh Reddy Voppuru, MD, an HVI thoracic surgeon at WVU Medicine, is at the forefront of this clinical implementation. According to Voppuru, PEF represents a departure from traditional ablation methods that rely on thermal energy.

Understanding Pulsed Electric Field Therapy

At its core, PEF is a nonthermal ablation technique that targets the structural integrity of malignant cells. "It relies on what we call irreversible electroporation—basically that induces force, or making holes in cancer cells, by passing electric currents through them, and then that causes cell death,” Voppuru explained.

The primary differentiator for PEF is the absence of extreme temperatures. In many thoracic procedures, heat (radiofrequency ablation) or cold (cryoablation) can risk damaging adjacent vital structures, such as blood vessels or the airway.

"Here, we're not using heat or cold or radiation; it’s just electric currents that damage the cancer cells," Voppuru said.

Addressing the Challenges of Advanced Lung Disease

The introduction of PEF therapy at WVU Medicine addresses a critical gap in the treatment of stage IV lung disease. When cancer has metastasized, the clinical objective often shifts from total eradication to long-term management.

"The challenge here is, once there is the stage IV disease, it's technically incurable, and then at that point, the goal of treatment would be to induce a stage almost like a chronic disease, so you try to keep it under control," Voppuru noted.

While the standard of care remains systemic—incorporating chemotherapy, immunotherapy, or targeted molecular therapies—many patients eventually reach a plateau or exhaust these options. This is where PEF therapy offers a unique physiological advantage beyond simple cell destruction.

"Once patients have exhausted multiple lines of these treatments, and then you're limited... that is where PEF could have a potential role, where it not only damages those cancer cells, it also induces a systemic immune response and also a localized immune response, which is said to bolster the effects of subsequent lines of systemic [therapy]," Voppuru said. "So far, what we've seen is that this helps to keep disease under check, if not a good complete response, at least stable disease, to stabilize the bulk process and prevent this from progression."

Technological Integration and Robotic Precision

The application of PEF at WVU Medicine is further enhanced by the use of robotic-assisted technology. Unlike previous iterations of electric field therapies, the current platform is designed for seamless integration into modern surgical workflows.

"There was a previous iteration of the technology, but this is more streamlined," Voppuru said. "The biggest advantage of the current technology that we have is that we can use it through the robotic bronchoscope that we use for obtaining biopsies from difficult-to-reach lung nodules."

By utilizing the robotic bronchoscope, surgeons can navigate the complex pathways of the lung with high precision to reach peripheral nodules. This technology can also be applied percutaneously via interventional radiology. Voppuru noted that "across the country, there are several places which have been using this technology, both via the bronchoscope and also percutaneously with interventional radiology."

The Future of PEF: The PROPEL Registry

As a relatively new modality in the oncological toolkit, PEF therapy is currently the subject of rigorous data collection and clinical research. WVU Medicine is contributing to this growing body of evidence through its participation in the PROPEL registry, a multicenter trial designed to track patient outcomes and refine the use of the technology.²

"Since this is relatively new technology on the market…we don't really have a lot of evidence database," Voppuru said. "The goal would be to create more evidence to fine-tune those indications, and that is where we are collaborating on a multicenter registry trial…and hopefully that should give us more answers to see what the best indications would be to use [PEF]."

Looking forward, the applications for PEF may expand beyond metastatic cases. Researchers are investigating whether the therapy could serve as a primary treatment for earlier stages of the disease.

"The future collaborations would be... to see if we can use this in early-stage disease as an alternative to what we currently have in the form of surgery or radiation, or augment the effects of chemotherapy in certain events, but also still amenable to surgery kind of situations," Voppuru said.

REFERENCES

1. WVU Medicine first in West Virginia to use pulse electric field therapy to treat metastatic lung nodules. News release. WVU Medicine. January 6, 2026. Accessed February 16, 2026. https://tinyurl.com/586b8fps

2. Galvanize Prospective/​Retrospective Pulsed Electric Field Device Registry (PROPEL). ClinicalTrials.gov. Updated January 15, 2026. Accessed February 16, 2026. https://clinicaltrials.gov/study/NCT05851430