Cryoablation allows safe and effective local control of breast cancer

Claudio Pusceddu

“Cryoablation of metastatic breast cancer is a safe and effective method that allows local control of the disease,” Claudio Pusceddu told delegates at the European Congress of Radiology (1–5 March, Vienna, Austria).

Pusceddu, who is director of Interventional Radiology, Hospital Oncology, Cagliari, Italy, presented on his team’s initial experience of using cryoablation as a local therapy for patient with metastatic breast cancer.

With cryoablation, noted Pusceddu, several observational studies have demonstrated a higher survival rate among patients with stage IV breast cancer in whom the primary tumour is completely excised at the time of diagnosis. He also emphasised that breast cryotherapy offered several advantages compared to other techniques: it is performed under local anaesthesia (an advantage for elderly patients and those with comorbidities); the procedure results in little, or no post-procedural pain; it is possible to monitor the ice-ball in real-time; there is minimal or absent post-ablation syndrome; and the procedure entails a short hospitalisation that usually consists of one day.

Pusceddu and colleagues set out to evaluate the safety and efficacy of breast cryoablation. They treated 39 breast lesions, mean size 2.1 cm (range 1–6.7cm) in 29 consecutive patients with a mean age of 51 years. All patients had core-needle biopsy-proven breast carcinoma. All patients included in this study presented with metastases at the beginning of disease. Twenty-three patients had one lesion; four patients had two lesions; one patient three lesions and one patient had five lesions.

The tumour and surrounding breast tissue were ablated with percutaneous CT-guided cryoablation under local anaesthesia. Cryoablation consisted of two cycles each of 10 minutes of freezing followed by a four minute active and four minute passive thawing phase for each one. Twenty-four patients underwent one cryoablation session, four patients underwent two cryoablation sessions and one patient underwent three cryoablation sessions.

All cryoablation sessions were successfully completed and all the tumours in the breast were ablated. There were transient and mild ecchymotic changes and post-procedural oedema seen in ten cases. The therapeutic outcomes were evaluated using contrast-enhanced CT or MRI at two-, six-, 12-, and 18-month intervals. The absence of tumour enhancement on CT or MR image was considered as indicating complete tumour necrosis. During the mean follow-up of 15 months (six to 28 months) 26 patients had shown complete response to the treatment. Only three patients out of 29 (10%) showed relapse close to the treated lesion. These patients were treated with a second cryoablation procedure.

“Cryoablation of the breast is a safe and effective procedure capable of obtaining complete destruction of the tumour without significant consequences. This method can effectively be used with good local control of the disease in patients who present with metastases at the beginning of the disease,” concluded Pusceddu.