Cryoablation Allows the Ultimate De-escalation of Surgical Therapy for Select Breast Cancer Patients

Background

Advances in breast cancer screening and early detection, along with the addition of radiation and systemic therapies, have led to less invasive treatments. This shift has moved breast cancer care from radical surgery to breast conservation and more personalized treatments. Now, even less invasive techniques, like cryoablation, radiofrequency ablation, laser ablation, and microwave ablation, are being considered as alternatives to surgery for breast cancer patients.

This study focuses on cryoablation as a potential next step in reducing surgical intervention for early-stage, low-risk breast cancer.

Methods

Between January 2017 and May 2023, 32 women (ages 50 – 91, median age 71) with early-stage breast cancer participated in this study. The mean tumor size was 8.7 mm (range 4.0 – 15.0 mm). All tumors were node-negative, Luminal A, estrogen receptor-positive (ER+), progesterone receptor-positive (PR+), and human epidermal growth factor receptor 2-negative (HER2-). Each participant underwent ultrasound-guided cryoablation (33 procedures in total, as one patient had cancer in both breasts). There were no major complications. Follow-up treatments included endocrine therapy (97%) or radiation (18.75%). Mammography and ultrasound check-ups were performed at 6 months, with MRI at baseline and 1-year intervals.

Results and Conclusions

All patients followed for two years or more (20 patients) were free from recurrence, with no tumor remaining at the cryoablation site. The overall recurrence-free rate was 96.9%.

The authors highlight several benefits of cryoablation over traditional lumpectomy, as noted by previous studies:

• Cost: Significant financial savings. Significantly, the average cost of cryoablation was $2,221.70, far lower than the $16,896.50 for lumpectomy. Patients reported a median financial well-being score of 38.0, compared to 10.0 for lumpectomy.
• Quality of Life (QOL): Cryoablation may improve QOL by reducing treatment demands and offering a less invasive approach. Accordingly, patients reported better physical, sexual, and cosmetic well-being than those who had surgery.
• Precision: Clear visualization of the ice-ball edge enables precise margin control during treatment.

The authors conclude that, for patients with early-stage, low-risk breast cancer, cryoablation offers a nonsurgical option that effectively eliminates cancer cells without the need for traditional resection.