Cryoablation of Early-Stage Breast Cancer: Work-in-Progress Report of a Multi-Institutional Trial

Abstract

Background: With recent improvements in breast imaging, our ability to identify small breast tumors has markedly improved, prompting significant interest in the use of ablation without surgical excision to treat early-stage breast cancer. We conducted a multi-institutional pilot safety study of cryoablation in the treatment of primary breast carcinomas.Methods: Twenty-nine patients with ultrasound-visible primary invasive breast cancer Յ2.0 cm were enrolled. Twenty-seven (93%) successfully underwent ultrasound-guided cryoablation with a tabletop argon gas-based cryoablation system with a double freeze/thaw cycle. Standard surgical resection was performed 1 to 4 weeks after cryoablation. Patients were monitored for complications, and pathology data were used to assess efficacy.Results: Cryoablation was successfully performed in an office-based setting with only local anesthesia. There were no complications to the procedure or postprocedural pain requiring narcotic pain medications. Cryoablation successfully destroyed 100% of cancers Ͻ1.0 cm. For tumors between 1.0 and 1.5 cm, this success rate was achieved only in patients with invasive ductal carcinoma without a significant ductal carcinoma-in-situ (DCIS) component. For unselected tumors Ͼ1.5 cm, cryoablation was not reliable with this technique. Patients with noncalcified DCIS were the cause of most cryoablation failures.Conclusions: Cryoablation is a safe and well-tolerated office-based procedure for the ablation of early-stage breast cancer. At this time, cryoablation should be limited to patients with invasive ductal carcinoma Յ1.5 cm and with Ͻ25% DCIS in the core biopsy. A multicenter phase II clinical trial is planned.

Percutaneous local ablation of unifocal subclinical breast cancer: clinical experience and preliminary results of cryotherapy

“…The simultaneous use of multiple probes, resulting in exponential summation of necrosis volume represents a questionable procedural complication in this organ application [9] . In literature there are numerous studies on invasive breast cancer cryoablation characterized by different selection criteria and results [9][10][11][12]. The extent of microcalcification visible on mammography often underestimates the true extention of carcinoma in situ and this is further restricted by the selection of patients to be treated.…”

Current Technique and Application of Percutaneous Cryotherapy

“…However, some special features must be taken into consideration. There is initially a significantly elevated risk of locally incomplete ablation in tumors > 2 cm so that the size is a decisive prognostic factor [46,47]. Moreover, most ablations were performed with ultrasound guidance.…”

Cryoimmunology for malignant bone and soft-tissue tumors

“…Recently, cryosurgery using liquid nitrogen has been successfully used for the ablation of tumors in the liver [28], prostate [29] and kidney [30], and the palliative treatment of locally advanced breast cancers [31].…”