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2 Introduction to HIFU High Intensity Focused Ultrasound (HIFU) is used to treat cancer tumours without requiring surgery. HIFU has been developed over more than 10 years and used to treat over 8,000 patients successfully worldwide. Having achieved European CE mark safety approval in 2005, it is now available to treat private patients.

3 What is HIFU Treatment? Our new equipment brings together low-power, imaging ultrasound, to locate and look at the tumour, and high intensity focused ultrasound to heat and destroy a precise volume of tissue within the tumour without harming surrounding structures: the healthy tissue through which the ultrasound passes is not affected. HIFU can be used to treat a variety of different tumours, but not all cancers are suitable for HIFU. You would be treated under a general anaesthetic to avoid discomfort and to keep you as still as possible. HIFU treatment can be in addition to any other medical treatment that you are receiving. The HIFU treated cancer cells are dead. Over a period of time they dissolve in the body without harmful effects. Indeed, there is some evidence that the treatment may stimulate the immune system, making the appearance of new cancers less likely. We would look at the tumour using magnetic resonance (MR) scans a couple of weeks after the treatment session, to confirm its success. Our work at Oxford is proving that certain cancers of the Liver and Kidneys can be successfully treated and certain cancers of the Bone, Breast and Pancreas may also be suitable. Further HIFU applications are under investigation. We are offering the treatment to private patients in conjunction with Oxford Radcliffe Private Healthcare. The treatment is carried out within the Oxford Radcliffe Hospitals; so the quality of the treatment is assured. The treatment is not currently funded in the NHS.

4 What are the benefits of HIFU treatment? HIFU has negligible side effects in comparison to conventional treatments. Chemotherapy can often be avoided and no radiotherapy is involved. There is no surgery, so no scar on the skin. HIFU involves no lengthy stay in hospital and very short recovery time. HIFU treatment is suitable for all ages. HIFU may stimulate the patient s anti-cancer immune system.

5 Where do I get HIFU treatment? The Ultrasound Therapeutics Ltd. dedicated HIFU unit at the Churchill Hospital was opened by Professor Sir Peter Morris, President of the Royal College of Surgeons with Katrina Leeder of the TV Airline programme (pictured) in attendance. The Churchill Hospital is part of the Oxford Radcliffe Hospitals NHS Trust and is a centre for cancer services with specialisations including treatment of liver and kidney cancer. What does the treatment involve? Treatment will start with appraisal by an appropriate specialist, coupled with a HIFU planning session (usually taking less than a day), to confirm your suitability for HIFU treatment. A few days later it is followed by the treatment itself, during which you will be anaesthetised to keep you still and to avoid discomfort. You lie above the ultrasound source and the cancer is treated. Small cancers can be dealt with in about two hours, but longer times are necessary for larger tumours. You will then need to stay in hospital for one night to ensure that you fully recover from the anaesthetics. About two weeks later we will ask you to return to the hospital to check the success of the treatment. Your doctor or consultant will no doubt continue to monitor your condition for some time. You will be treated in a world-leading healthcare and medical training institution with a national and international reputation for the excellence of its services and research. Every important clinical service is provided, which gives you peace of mind and confidence in your private care, under all circumstances for all conditions.... Kidney Cancer Without HIFU, kidney cancer generally requires surgery, and any remaining cancer is treated using radiotherapy and/or anti-cancer drugs. Survival rates vary dependent on the type of cancer and how soon it is treated. Treating kidney cancers with HIFU can cause less trauma and can, in some cases, help to avoid a lifetime of dialysis. Liver Cancer A tumour in the liver, which would often be removed by surgery, may now be suitable for HIFU treatment. In some cases it is not possible to cure secondary cancers in the liver, and anti-cancer drugs are often prescribed to slow down progress of the disease. In such cases treatment with HIFU may significantly improve the patient s outlook and help to control further spread of the disease. Bone Cancer HIFU is a safe, effective method of treating certain types of localised solid tumours. It has the great advantage that it can avoid amputation of affected limbs. Other Cancers The intense pain associated with advanced cancers may be reduced by HIFU. If suitable, cancers caught in the early stage of development, which would either be removed or treated with radiotherapy and anti-cancer drugs, can now be treated with HIFU. These may include cancers in the breast, pancreas or soft tissue.

6 I didn t know it was done John Madden was found to be suffering from high blood pressure, when he was having a cartilage operation on his knee. On referral to the Oxford Radcliffe Hospital for assessment a small tumour was discovered in his right kidney. This had to be removed and the consultant advised him that the removal by surgery brought with it the likelihood of his being on dialysis for the rest of his life, as his kidney function was poor. He didn t want dialysis and so he was advised about the HIFU alternative. After considering the position John decided to have HIFU treatment in August John was astonished at how simple the procedure was, with no scar or other after-effects. He said, I didn t know it was done. Since treatment, MRI scans show the tumour to have no blood supply and no residual enhancement. Eighteen months on and John is happily enjoying a normal life, back on the golf course and very pleased he heard about the HIFU alternative. He says, I m enjoying a dialysis-free lifestyle thanks to HIFU.

7 Common Questions Q. How does HIFU kill cancer cells but not healthy ones? A. Unfocused ultrasound waves can pass through human tissue without affecting it. It is only at the HIFU focus that sufficient energy is generated to heat and kill the cancer cells. Q. How do you know that you are treating only the cancer cells? A. The cancer is located by imaging ultrasound and that is used to ensure that the HIFU is focused on the cancer. Q. Are there truly no adverse side or after effects? A. Particularly if the cancer lies relatively near to the skin, it is possible that small blisters - the equivalent of sunburn - can occur. This is rare, and the blisters disappear in a day or so. We have found that some patients feel some discomfort internally for a few days after the treatment. Standard pain killers provide relief. Q. Can I have HIFU treatment even if I have already had some other cancer treatment? A. Yes. And because ultrasound is non-toxic, there are no side effects such as hair loss. There is no limit to the number of HIFU treatments you can have. Q. What experience has there been of using this HIFU equipment? A. Upwards of 8000 patients have been treated with this HIFU equipment worldwide, and our work in Oxford confirms the claims for the successful treatment of certain cancers. Q. Are there any more benefits of the treatment? A. It has been reported that the intense pain associated particularly with pancreatic cancer is reduced by HIFU treatment. And in contrast to conventional surgery, there is no visible operation scar. Cosmetically and emotionally this can be important. Sometimes HIFU treatment of a kidney tumour, rather than its surgical removal, will allow continued functioning of the kidney and thus avoid subsequent dialysis. Q. Are there other cancers than the ones you have listed that can be treated? A. This is a developing technology, and many new uses are being found. Q. Is HIFU suitable for you? A. In order for us to assess if HIFU treatment is suitable for you we need information about your condition from your doctor or consultant. Take a moment to check if HIFU treatment is suitable to treat your cancer and to obtain a patient information sheet and referral form, by going to either: or the patient hotline: +44 (0)

8 The HIFU Unit, Churchill Hospital Headington, Oxford, OX3 7LJ, U.K. Telephone: +44 (0) This brochure provides an overview of the potential benefits of HIFU for the treatment of certain cancers. To the best of our knowledge it is correct at the time of printing in April Each HIFU treatment is undertaken after appropriate professional investigation, advice and counselling and no responsibilty can be accepted by Ultrasound Therapeutics Ltd for any clinical problem arising from individual treatments.