It sounds like the stuff of science fiction: Instead of having a surgical lumpectomy to remove a breast cancer tumor, a thin needle-like device is inserted into the mass and a blast of extreme coldness destroys the cancerous cells. There’s no hospitalization, no sedation, no pain and no scarring involved. It may seem like sheer fantasy but it’s becoming a reality. This non-surgical, non-invasive deep-freezing technique, called cryoablation, was found to be a viable alternative to traditional surgery for many early-stage breast cancers, according to a recent clinical trial involving 86 patients at 19 medical centers across the country.
"It’s a huge advance for women — I think this could be the wave of the future," says study lead author Dr. Rache Simmons, chief of breast surgery at New York-Presbyterian/Weill Cornell Medical Center. "The beauty of it is it takes less than half an hour, then the patient goes home with a Band-Aid on the tiny incision. There’s no recovery time." The procedure, which has been used for many years to treat benign breast tumors called fibroadenomas, as well as cancers of the liver and kidney, can be performed in an outpatient setting with only a topical anesthetic applied to the skin.
With cryoablation, doctors use ultrasound imaging to guide a thin, needle-like device through the skin and into a breast tumor, where it emits liquid nitrogen to freeze and destroy the cancerous tissue. The doctor’s proficiency with ultrasound is key. "You really need to be spot on with this or you’re not going to get a good result," Simmons says. The process involves two freezing cycles of five to eight minutes each, with a thawing phase in between, to produce a higher cell death. "You can watch it on ultrasound — the process forms an ice ball that engulfs the tumor," explains Dr. Rosa Hwang, an associate professor in the departments of breast surgical oncology and surgical oncology at the MD Anderson Cancer Center in Houston who participated in the study. "The procedure is painless; a patient just feels a sensation of coolness."
In the multi-center trial, the technique was used on patients with invasive ductal breast tumors of 2 centimeters or smaller that could be seen on ultrasound. Before and after the cryoablation procedure, MRIs were done to look at the tumor, and after the procedure, tissue from the former tumor was examined to see if all the cancerous cells were killed. The results: Cryoablation was successful — meaning, no remaining cancer was found — in 92 percent of the targeted lesions, and there was 100 percent ablation in tumors smaller than 1 cm. Over time, the body reabsorbs the destroyed cancer cells, and once that happens, no traces of the cancer are seen on a mammogram or subsequent imaging scan, Simmons says.
Besides the no-pain, no-scarring advantages, there’s another potential perk with this technique: "The possibility that freezing a cancer and leaving it in the body to be absorbed may stimulate an anti-cancer immune response," explains Dr. Michael Sabel, chief of surgical oncology at the University of Michigan Hospital in Ann Arbor, who also participated in the study. "This has been demonstrated in mice and we are now studying this in patients."
With metastatic breast cancer, in particular, "we have found that if we ablate the original cancer, the metastatic disease goes away in a mouse model," Simmons explains. "What we think is happening is the cryoablation makes the cells burst and they release all that cancer DNA into the system. The body’s immune system almost acts as an auto-vaccine against the cancer," which could help reduce the chances of a recurrence as well.
After cryoablation, patients are seen for follow-up, including mammograms, every six months for the first five years, then annually after that, Simmons says. To lower their risk of developing another cancer, some women may opt to take an aromatase inhibitor or have radiation. But some may not need either. "It depends on what kind of cancer the tumor was," Hwang says.
Right now, cryoablation is being used on an experimental basis on women with small tumors that are hormone receptor positive and HER-2 negative. If further studies confirm the treatment works effectively and safely in this population, its use may expand gradually. Already, "some surgeons are willing to do this for patients who aren’t eligible for surgery with general anesthesia," Hwang says.
Within the next several years, experts say, this may become an option for more women with breast cancer. But "given that lumpectomy, despite its disadvantages, does a very good job of preventing the cancer from coming back, we need to be sure that cryoablation will be just as effective before we can offer this as a standard treatment," Sabel says. Only time and further research will tell, but right now the potential looks promising.
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