My specialist interest is in Interventional Oncology (IO) dealing with the diagnosis and treatment of cancer and cancer-related problems using minimally invasive procedures performed under image guidance. Thermal ablative energy e.g. heat (radiofrequency and microwave) or cold (cryoablation) energy can be used to destroy the tumours.
Worldwide incidence of cancer is rising particularly for liver, lung, kidney and many other tumour types. With the greater availability of radiology imaging over the last decade, we are seeing a surge of smaller cancers being detected during radiology scanning for a variety of reasons. This has led to the natural evolution of a minimally invasive approach e.g. image guided ablation to treat these smaller cancers aiming to avoid the need for conventional surgery. Image guided ablation has been one of the most rapidly evolving treatments for cancer over the last decade and it is now capturing the attention worldwide. This treatment has gradually been replacing surgery for smaller cancers. It offers a safe, effective, organ sparing, cost effective procedure with a short hospital stay (often overnight) thus freeing up hospital beds and providing a shorter recovery time.
Following my sabbatical from LTHT to Massachusetts General Hospital, Harvard Medical School at Boston, under Prof Peter Mueller in 2003, I returned to Leeds to develop Interventional Ooncology for LTHT. Initially the heat based energy was used followed by cold based energy to treat a range of cancers.
I have been the lead for IO programme in Leeds Teaching Hospitals Trust (LTHT) over the last 10 years and provide minimally invasive treatment for cancer in kidney, liver, lung and adrenal gland for the patients in West Yorkshire and beyond. LTHT is currently a national and supra-regional centre for this specialist treatment and this IO programme is also one of the largest programmes in the UK. Our image guided treatment for kidney cancer clinical series is one of the two largest in the country- we have performed treatments for over 300 renal tumours using heat (fire-ball) or cold (ice-ball) energy. The choice of using fire-ball or ice ball treatment in kidney cancer depends on the size, tumour location and the kidney function e.g. whether there is renal function impairment or the patient has a single kidney.
In cryoablation, the ice ball can usually be seen clearly on the CT scan during treatment and the ability to be more precise of the exact treatment margin hence allows precise ‘ice ball margin’ that simulate surgical resection approach. Therefore there is a massive surge in the increased popularity to treat patients with renal function impairment or a single kidney with kidney cancer using this approach.
It is particular importance in order to preserve kidney function, as going on renal dialysis limits the lifestyle and for patients over 60 years of age the average survival period is around 5 years once dialysis is initiated according to Dr Chas Newstead, senior consultant nephrologist at LTHT (personal communication). In addition, the costs for the renal dialysis are significant at around £25,000/year with a cumulative cost of £125,000 over 5 years. The quality of the patient’s life is also significantly impaired.
On a personal front, I feel really privileged to be able to provide this kidney-saving treatment for kidney cancer patients in order to avoid renal dialysis for them. For each and every kidney I manage to save the sense of fulfilment remains magical and this has inspired us to strive to provide a better service for the patient population that we serve at LTHT.