Freezing Tumors Could Be New Treatment for Low-Risk Breast Cancers
A first-of-its-kind study suggests that slow-growing breast cancers can be treated with a highly targeted tumor-freezing technique, eliminating the need for invasive surgery.
Testing to date suggests that the technique is effective among women over 60 diagnosed with relatively low-risk breast cancer.
"Cryoablation is a minimally invasive solution that destroys breast tumors safely, quickly and painlessly, without the need for surgery," said study author Dr. Richard Fine, a breast surgeon with West Cancer Center & Research Institute in Germantown, Tenn.
"The procedure exposes diseased tissue to extreme cold [cryo] to destroy [ablate] it," he added. "It is performed in the office while the patient is awake."
The new study -- which involved nearly 200 women -- found that when cryoablation was performed on women with low-grade/low-risk breast cancer nearly all the patients remained cancer-free three years out.
"The therapy is already well established for the treatment of bone, kidney, prostate and other cancers," Fine noted.
Average age of patients in the study was 75, and all were diagnosed with "invasive ductal carcinoma" breast cancer. Tumors were relatively small, measuring no more than 1.5 centimeters in size. All the patients had "hormone receptor-positive" tumors, meaning tumors that were ER+, PR+ and/or HER2-.
"In general, tumors that are ER+ and/or PR+ are slightly slower growing, and have a slightly better prognosis than tumors that are hormone receptor-negative," Fine said.
All the patients in the study underwent cyroablation, which involved direct insertion of a probe through the skin and into the tumor site, under localized anesthesia. In turn, liquid nitrogen was applied to freeze the targeted tumors from the inside out. Treatment lasted between 20 and 40 minutes, ultimately turning tumors into balls of ice.
The procedure removed the need for follow-up surgery, the researchers reported, although nearly 15% of the women also underwent radiation, while about 3/4 were further treated with endocrine therapy. One patient underwent chemotherapy.
Patients were checked twice yearly, as far out as five years following treatment. The result: By an average follow-up point of nearly three years post-treatment just 2% (four patients) had seen their cancer return. No serious side effects were reported, and nearly all the patients and attending physicians reported being satisfied with the treatment (95% and 98%, respectively).
"For both benign and cancerous tumors, benefits over traditional surgery include office-based procedures, [that were] faster, [entailed] almost immediate recovery, improved cosmetic results, greater patient comfort, less procedural risk and lower cost," Fine said.
Unlike a conventional lumpectomy or mastectomy, he added, cyroablation preserves breast volume and minimizes infection risk. And the process usually produces "excellent cosmetic results with no scarring," while allowing patients to quickly resume normal activity.
Fine noted that the European Union approved cryoablation for breast cancer in 2010, with the procedure similarly approved for use in Australia, South Africa, Thailand, Singapore and Hong Kong.
In the United States, "the treatment is in experimental use", explained Dr. Shawna Willey, chair of breast cancer research with the Inova Schar Cancer Institute at the Inova Fairfax Hospital in Fairfax, Va.
"If it continues with similar success, data will be submitted to the FDA [U.S. Food and Drug Administration] to obtain the first-ever approval for use of a specific cryoablation device in breast cancer treatment for the tumor and patient parameters studied," Willey added.
Though not part of the study team, she noted that Fine's trial "is the largest of its kind, and may lead the way to cryoablation being far more widely available as a treatment option for older women with low-risk breast cancers, while it continues to be studied in broader patient populations."
Still, Willey cautioned that cryoablation has only been tested among carefully selected breast cancer patient groups. So its effectiveness, she stressed, "is not backed by extensive data with long-term follow-up, or by data on a broad range of tumor types across women of all age groups."
Fine and his colleagues presented their findings this week at a virtual meeting of the American Society of Breast Surgeons. Such research is considered preliminary until published in a peer-reviewed journal.
There's more information on how cryoablation and cancer at Mayo Clinic.
SOURCES: Richard Fine, MD, breast surgeon, West Cancer Center & Research Institute, Germantown, Tenn.; Shawna Willey, MD, chair, breast cancer research, Inova Schar Cancer Institute, Inova Fairfax Hospital, Fairfax, Va.; American Society of Breast Surgeons virtual annual meeting, April 29-May 2 (platform open through June 2), 2021