MORE than 50 world-leading liver cancer centres are now using microwave machines to treat patients with liver cancer under a system pioneered in the UK.

David Lloyd, a consultant surgeon based in Leicester, central England, has developed a probe that uses microwave energy to kill cancerous tissue. More than 100 patients in the United Kingdom and 100 other patients from across the world have been treated.

The use of microwave energy to treat cancer is proving to be very successful. Globally, 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, and it is very common in Asia and the Far East where it is associated with endemic hepatitis B and C. Most patients with liver cancer are deemed inoperable but with the development of this microwave equipment, thousands of patients worldwide could be offered treatment.

David Lloyd, MBBS, MD, FRCS, a consultant surgeon with University Hospitals Leicester NHS Trust, is also acclaimed for his innovative work in keyhole surgery.

His research, in collaboration with Professor Nigel Cronin and Dr Peter Clegg at the University of Bath, western England, has led to the development and production of a microwave generator and probe that is being manufactured by UK company Acculis.

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 fewer than 12 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 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 David 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 United States 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 Center in Texas.

David Lloyd added: "We have placed several in France and Switzerland and many of the world's leading liver surgeons are now using the generator. A worldwide database has now been set up by AUGIS [the Association of Upper Gastrointestinal Surgeons of Great Britain & Ireland] to document and audit the results worldwide. This is the first time there has been such a collaboration between many of the leading liver surgeons in the world."

Because Lloyd was the only surgeon with this specialised equipment, he was referred patients from across the world for treatment. He says 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, London and Edinburgh.

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 fast and produces cancer cell death with very few side-effects.

"Microwaves don't cause collateral damage elsewhere in the body," said David Lloyd. "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 centimetres in diameter within 4-6 minutes. This makes it ideal for someone who may have multiple tumours, which by other techniques, might take hours to treat.

He continued: "People have come to Leicester from all over the world. It has really put Leicester on the map, within this field. For the last 10 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. The Acculis system is safe, fast and reproducible and it does work.

"If it is used correctly there are no side-effects but because this is a very powerful device it has to be used very carefully. I tend to work in collaboration with a radiologist so that accurate placement of the microwave probe can be achieved," added Lloyd.

The machines cost 15,000 to 20,000 pounds, and probes (per patient) 1,000 pounds. In terms of medical equipment this is not a prohibitive sum. Chemotherapy costs 2,000-3,000 pounds per month and intensive-care beds up to 3,000 pounds per day. The use of the microwave machine cuts out any need for intensive-care beds.

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 such as lung and kidney cancers.

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 under way 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 hip replacements, which, he believes, could save thousands of blood transfusions.