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Worldwide success in treatment of liver tumours

The technique behind the Acculis microwave generator (above), developed by Mr David Lloyd, has had great success in treating patients with liver cancer.

Worldwide success in treatment of liver tumours

An innovative technique using microwaves for medical applications has been developed by Honorary Senior Lecturer David Lloyd

A picture of the Acculis microwave generator is available from the University of Leicester Press Office: email - pressoffice@le.ac.uk, tel +44 (0)116 252 2415.

A Leicester consultant surgeon who has developed a pioneering technique using microwaves to destroy liver tumours has treated more than 100 patients in the UK and other patients are now being treated internationally.

Worldwide, about one million people a year die of primary liver cancer, with another million dying with secondary liver cancer where the cancer has spread from other tumour sites such as cancer of the colon.

The incidence of primary liver cancer is gradually increasing in the Western world, but it is very common in Asia and the Far East where it is associated with endemic hepatitis. Most patients with liver cancer are deemed inoperable but with the development of this microwave equipment, literally thousands of patients worldwide could be offered curative treatment, even if they have established liver cirrhosis.

Mr David M Lloyd, MBBS, MD, FRCS, a consultant surgeon with University Hospitals Leicester NHS Trust, is also acclaimed for his innovative work in keyhole surgery. The University of Leicester has awarded him an Honorary Senior Lectureship, and earlier this month he won the title of Honoured Citizen of the Year for the City of Leicester.

David Lloyd’s research, in collaboration with Professor Nigel Cronin and Dr. Peter Clegg at the University of Bath, has led to the development and production of a microwave generator and probe, now being manufactured by Acculis Ltd, UK. The treatment of more than 100 patients with liver cancer has resulted in curing or extending life for many of them, whose life prognosis was less than twelve months. More than one third of the patients treated are still alive after three years and some have been, quite simply, pronounced cured and discharged.

The earliest patient to be discharged is one of David Lloyd’s trial patients treated nine years ago. Several more are alive and well five years after receiving treatment.

The importance of this application of microwave technology is immense, as Mr Lloyd explained: “The technique will have a significant effect on liver cancers, because we are operating on people who have been declared inoperable. Someone with cirrhosis of the liver can’t be operated on in a conventional way to remove a tumour, but we can place a microwave probe in by keyhole or percutaneous (through the skin) methods and can destroy these tumours.”

Because of the pioneering research done at the University Hospitals Leicester, the microwave generator is being used as far afield as Hong Kong, Singapore, the USA and Australia. In particular, the microwave technology has been embraced by many of the top cancer hospitals in the US, including the Memorial Sloan-Kettering Cancer Institute in New York, The Johns Hopkins University in Baltimore, and the M D Anderson Cancer Centre in Texas. Mr Lloyd added: “We’ve placed several in France and Switzerland and many of the world’s leading liver surgeons have now expressed an interest in using the generator.

Because David Lloyd was the only surgeon with this specialised equipment he was referred patients from all over the world for treatment. He is extremely pleased that more centres are now using the microwave device and, in the UK, there are now generators in major teaching hospitals in Liverpool, Manchester, Leeds, Basingstoke and Edinburgh. David Lloyd calculates that within a couple of years, every major liver centre in the UK will probably have a microwave generator.

The advantage the microwave technique has over other machines designed to destroy tumours, such as laser, ultrasound and radio-frequency (which is similar to an electric current) is that it is quick and produces cancer cell death with very few side effects.

Only tissue in the immediate field of the microwave energy is destroyed, David Lloyd explained, and not in other parts of the body, which is a danger with other methods, such as radio-frequency, where the electric current has to have an exit point from the body, with the risk of burning at that site.

“Microwaves don’t cause collateral damage elsewhere in the body,” he said. “They only heat up the tissue at the end of the probe and no energy is sent through the body. We can now treat very large tumours up to 6-8 cms in diameter within 4-6 minutes. This makes it ideal for someone who may have multiple tumours, which by other techniques, might take several hours to treat.

“People have come to Leicester from all over the world,” he added. “It has really put Leicester on the map, within this field. For the last ten years I have been invited to every world and European congress in liver surgery to talk about this development. There has been tremendous interest because of the frustration with other forms of energy which haven’t delivered. Our system is safe, fast and reproducible and it does work.

“If it’s used correctly there are no side effects, but because this is a very powerful device, it has to be used correctly. I tend to work in collaboration with a radiologist so that accurate placement of the microwave probe can be achieved. We have not seen significant side-effects so far.”

Discussions between David Lloyd, gynaecologist Professor Ellis Downes and scientists at the University of Bath led to the adaptation of an existing technique used to treat women with heavy menstrual periods. This technique was Microwave Endometrial Ablation (MEA), owned and marketed by Microsulis Medical Limited.

A period of laboratory work started in 2000, proving that the technique could destroy cancers, and in 2005 it was fine-tuned to settings that would destroy tumours most efficiently.

This period of collaborative research culminated in the development by Microsulis of a purpose designed system and applicators for the treatment of liver cancers.

The company was taken over by Acculis Ltd, and continued working with David Lloyd to develop a commercial machine that could be used round the world. Machines cost £15,000-£20,000, and probes (per patient) cost £1,000.

In terms of medical equipment, however, this is not a prohibitive sum. Chemotherapy costs £2,000-£3,000 per month and intensive care beds up to £3,000 per day. The use of the microwave machine cuts out any need for intensive care beds.

All clinical work and research takes place at Leicester, where David Lloyd, of the Department of Cancer and Molecular Medicine at University of Leicester, is about to take on his fifth PhD student to continue working on the project. The development of the Acculis machine is sited in Bath, working to the standards of the MHRA (Medicines and Healthcare Products Regulatory Agency) and with continual consultation between Leicester and Bath.

Current research plans include studies into the implications of using the technique for even bigger liver tumours of 8-10 cms, as well as worldwide investigations into the possible advantages of using microwaves for non-liver tumours.

With the success of this work in liver tumours, Acculis has received a government grant to look at treating bone cancer and work has begun in collaboration with a radiologist in London to work on the treatment of bone deposits. Further afield, the technique has already begun to be used on lung and breast tumours and early discussions are underway to explore its use in the treatment of brain tumours.

David Lloyd is also exploring its potential as a haemostatic agent that can stop or limit bleeding during surgery such as liver transections and hip replacements, which, he believes, could save thousands of blood transfusions.

Other applications are looking at sending microwave energy down long wires, which can be used to burn away tiny tumours, or stop blood vessels or gastrointestinal ulcers bleeding. The potential already exists to use microwave technology to destroy varicose veins, instead of stripping them using conventional surgery.

So far the development of microwave technology to destroy liver tumours has been an incredible success. The initial idea, first explored some 10 years ago has spread around the world. It has, as Mr Lloyd has pointed out, put Leicester on the map. But more importantly, it has given life to hundreds of people who thought they had no hope of surviving liver cancer.

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