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World's first heart surgery using radiation


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World's first heart surgery using radiation
A British man has become the first person in the world to undergo heart surgery using radiation.

By Rebecca Smith, Medical Editor
Published: 9:00AM GMT 02 Nov 2009
Michael Kilby, 67, was told he may only live until Christmas after doctors found a tumour inside the right chamber of his heart larger than a golf ball. It was so big it was blocking the blood flow and he was dying.
After conventional surgery, radiotherapy and chemotherapy, his last option was to try revolutionary surgery involving highly focused radiation as a 'scalpel' to cut away the tumour inside his beating heart.

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Now just 10 days later he is planning a five month trip to Australia, Indonesia, New Zealand and America with his wife, Licette Gus.
The treatment is the first time the radiation scalpel, called the Cyberknife, has been used in heart surgery and doctors are confident that it could lead to new treatments for other heart conditions.
Radiation beams controlled by a robotic with an accuracy of one millimetre arm attack the tumour. It is able to take account of breathing patterns and body movements to avoid healthy tissue. Pieces of gold were attached to Mr Kilby's heart to act as an extra guide.
Mr Kilby was diagnosed with a rare cancer of the duodenum, part of the small intestine, 10 years ago which was successfully removed.
Then three years ago a secondary cancer was found in his right lung and one third of it was removed.
But then in a third blow, he began suffering severe breathlessness and a scan found a large tumour had formed inside his heart.
Surgeons at the private Harley Street Clinic in London first carried out emergency open heart surgery to try and take out as much as they could, but the tumour had burrowed into the muscle of the heart and it could not all be safely removed.
Conventional radiotherapy and chemotherapy failed and the tumour began to grow again within just six weeks.
When Mr Kilby, a retired businessman from Moreton in Marsh, Glouchestershire, was about to give up and accept his fate, it was suggested he try the Cyberknife.
The technique had never been used on the heart before and because the operation was experimental Mr Kilby's health insurance would not cover it.
After consulting his wife and their three grown up children, he decided to pay the £22,000 required and the course of five treatments began.
The tumour has already shrunk by 40 per cent and is expected to shrink further over the next three to four weeks.
Mr Kilby said: "My options were to give the Cyberknife a go or I was going to die by Christmas. I talked to my wife and the children who said they did not want any inheritance so we went for it.
"I was treated for five days with each session lasting for about an hour and a half. You cannot feel anything at all, its just like radiotherapy.
"Before the Cyberknife I couldn't speak in long sentences because I would get out breath, but now I can walk a few holes of the golf course."
Nick Plowman, clinical oncologist, said: "This was an absolutely unique case. The tumour was taking up so much of the ventricle that the heart was failing in front of us. There was nowhere else to go with his treatment.
"The tumour has shrunk significantly and I expect it to shrink further in the coming weeks. It is great."
Dr John Coltart, consultant cardiologist at the Harley Street Clinic, in London, said: "Three months ago his prognosis was terrible, now he may live for a good while yet. No one had ever done this before, it was a bit of innovative thinking to give this gentleman a chance.
"All our expectations have been realised."
Dr Coltart said tumours inside the heart are extremely rare and it seems that the Cyberknife may now be the preferable way to treat them because the radiation can be targeted to such a degree that there is minimal damage to the heart muscle.
He said such tumours inside the heart are extremely rare, with probably only 40 or 50 found each year in Britain, with few being operable.
Dr Coltart said as well as opening possibilities for other heart tumours to be treated, the Cyberknife could be used in future to treat arrythymia, where the heart beats erratically or fast.
Normally a fine wire is passed into the heart to destroy the tiny piece of heart muscle that is causing the abnormal electrical pulse, but the Cyberknife could also be used to do this in a less invasive procedure, Dr Coltart said.