Cryoablative Techniques for Benign and Malignant Diseases of the Breast

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Cryoablative Techniques for Benign and Malignant
Diseases of the Breast

• Rache M. Simmons, MD FACS
• Anne K. and Edwin C. Weiskopf Associate Professor
  of Surgical Oncology
• Medical Director of Clinical Research
• Joan and Sanford Weill Medical College of Cornell
  University
• The New York Presbyterian Hospital
• New York, NY

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Ablative Techniques

• Longstanding successful treatment of metastatic
  hepatic tumors
• Similar technology now being applied as primary
  treatment for variety of tumors including breast
• Current ablative techniques under investigation
  include
• radiofrequency
• laser
• cryoablation
• focused ultrasound (FUS) , microwave
• All image-guided (ultrasound, stereotactic
  mammography or MR) which allows three dimensional
  localization of tumor
• Core biopsy pre-ablation for definitive
  diagnosis, ER/PR, Her-2/neu, other markers
• Ablation of breast lesions can be performed in
  the office setting
• May offer patients an alternative to surgical
  excision for treatment of benign and malignant
  disease

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Cryoablative Technique

• FDA approved treatment fibroadenomas
• Local anesthetic to skin freezing acts as
  anesthetic to deep tissue
• Argon gas creates sonographic freezeball
• Real-time encompass tumor and adjust distance to
  skin

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Cryoablation of Fibroadenomas

• Multi-institutional series (50 patients)
• Core biopsy dx followed by cryoablation w/o
  resection
• Tumor size
• range 0.7cm-4.2cm
• median 2.0 cm
• Tumor volume decrease
• 95 at 12 months
• Resolution on PE, sono, and mammography
• Kaufman, Bachman, Littrup, White, Carolin,
  Freman-Gibb, Francescatti, Stocks, Smith, Henry,
  Bailey, Harness, Simmons
• AJS, 184, 2002

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Cryoablation of Fibroadenomas

• Kaufman et al, multi-institutional series 50
  patient update
• Avg treatment time 24 min (range 12-30 min)
• In office 79, ambulatory OR 21
• Patient satisfaction 94 at 12 months
• Kaufman, Littrup, Freman-Gib, Francescatti,
  Stocks, Smith, Henry, Bailey, Harness, Simmons
• JACS, 198, 2004

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Cryoablation of Breast Cancers

• 27 breast T1 invasive breast cancers
• Mean tumor size 1.2cm (range 0.6-2.0cm)
• Core bx for dx/tumor markers
• Ultrasound guided cryoablation
• Surgical resection by lumpectomy post ablation
• Average time to resection 14 days (range 6-30
  days)
• SLNB performed in 25/27 patients
• 100 ablation for IFDC/-EIC 1.5cm
• M. Sable, C. Kaufman, P. Whitworth, H. Change, L.
  Stocks, R. Simmons, M. Schultz
• Ann Surg Onc, 2004

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Cryoablation Breast Cancer Studies Rand
et al, Cryobiology, 1985Staren et al, Arch Surg,
1997Stocks et al, Abstract, Amer Soc of Breast
Surgeons, 2002
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ACOSOG Z1072Phase II Trial Evaluating the
Efficacy of Pre and Post Treatment Imaging to
Determine Residual Disease in Patients with
Invasive Breast Carcinoma Undergoing Cryoablation
Therapy
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SummaryPro Cryoablation for treatment of benign
and malignant breast disease

• Smaller incision or no incision
• Less long term physical change to the breast
• Less invasive office based treatment option
  especially if slnb not performed in the future
• More cost effective than surgical excision
• Less discomfort in procedure and post-procedure
  recovery
• Potentially less residual imaging distortion
• Potentially favorable immunologic response to
  treatment

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Conclusions

• There are data that ablation is effective in
  destroying breast tumors.
• It is optimistic that ablative therapy will be
  used in the future to treat women with small
  breast cancers without the need for surgical
  resection as an office procedure

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