Purpose: Breast cancer cryoablation has been performed with both palliative and curative intent. ICE3 trial interim results for breast cancer cryoablation with curative intent indicated a success rate (98%) similar to breast conserving surgery. Although palliative breast cancer cryoablation has demonstrated survival benefits in case studies, treatment efficacy has not been defined. Thus, we provide specific treatment objectives in the setting of palliative breast cancer cryoablation to determine treatment efficacy.
Materials and Methods: Internal review board-approved retrospective analysis was conducted on patients who underwent breast cancer cryoablation from November 1, 2021 to April 1, 2023. Breast radiologists performed outpatient cryoablation under local anesthesia, using Argon gas cryoprobes with ultrasound (US) or MRI guidance. Patient demographics, referral indications, tumor characteristics, treatment details, and imaging follow up (FU) [mammography (M), US, MRI] were analyzed. Treatment objectives defined as pain control, skin/nipple erosion prevention, and tumor volume control were evaluated prior to and after treatment.
Results: Palliative breast cryoablation was performed on 16 malignancies in 12 patients with imaging follow up of >6 months (9-18, median 11months) available for 14 malignancies [7/14 (50%) M+US+MRI and 7/14 (50%) M+US] in 10 patients [age 68-92 (median 76)] with mostly N0M0 disease (7/10;70%) [N1M0 (1;10%), N2M0 (1;10%), N0M1 (1;10%)]. Referral reasons included: standard of care treatment declinature (6/10;60%), comorbidities at high risk for surgical complications (3;30%), and stage IV metastatic breast cancer (1;10%). Thirteen (93%) malignancies (0.6-3.2 cm size, median 1.0 cm) were ablated with single cryoprobe/US guidance and 1 malignancy (6 cm) with 5 cryoprobes/MRI guidance. Ablated malignancies were mostly invasive ductal carcinoma (IDC, 9/14; 64%) [IDC+ ductal carcinoma in situ (2;14%), IDC + invasive lobular carcinoma (1;7%), invasive papillary carcinoma (1;7%), intramammary lymph node metastasis (1;7%)] and ER+/PR+/HER2- (9/14;64%) [ER-/PR-/HER2- (TNBC, 4;29%), ER+/PR-/HER2- (1; 7%)]. Nine (90%) patients demonstrated no residual/recurrent carcinoma nor nodal progression on imaging and on pathology (1 biopsy and 1 debridement). All 10 patients met pretreatment objectives of tumor volume control with no skin/nipple erosion. One patient had resolution of nipple pain. Procedure complication was limited to 1 skin injury, requiring wound treatment and debridement under local anesthesia.
Conclusion: Breast cancer cryoablation is a minimally invasive outpatient procedure that achieves treatment objectives without significant complications and may be performed in select patients for palliative and local disease control.
Clinical Relevance Statement: While we report early treatment efficacy of palliative breast cancer cryoablation, additional research is needed to determine the best application and measurement of efficacy.
