Breast cancer cryoablation safe alternative for high-risk patients, suggests study

Breast cancer cryoablation is a minimally invasive procedure that uses extreme cold to destroy cancer cells. The corresponding clinical trials are extremely selective in their inclusion criteria and usually involve only patients with potentially treatable diseases. This study evaluated the safety and outcomes of cryoablation in a real-world, broader patient population: those ineligible for clinical trials because of unfavorable patient or tumor characteristics.

The primary endpoint of the study was to assess the safety and efficacy of cryoablation of breast cancer without surgical excision in patients ineligible for clinical trials. This was a retrospective study of women who underwent cryoablation of biopsy-proven unifocal primary breast cancer with locally curative intent. These procedures were carried out from 1 January 2000 to 26 August 2021 in seven institutions. Adverse events were recorded, with the cryoablation procedures labeled as technically successful if they met parameters for the treatment with no reveal of residual disease at first imaging follow-up. Follow-up biopsies and ipsilateral breast tumor recurrences (IBTR) also were documented.

The final study sample included 112 patients with a median age of 71 years. The findings are as follows:

• Only 6.3% of the patients developed minor AEs; no moderate or major AEs were reported.

• Technical success was achieved in 98.2% (110/112) of the cryoablation procedures.

• Over a median follow-up of 2.0 years, 20.0% of patients had undergone biopsies for suspicious imaging findings. Of these, 40.9% (9/22) were benign, and 54.5% (12/22) were IBTR.

• 10.9% (12/110) of patients experienced IBTR, with 7 cases of true recurrence and 5 of new primary disease. Among these, 25.0% (3/12) had received earlier adjuvant or neoadjuvant therapy.

When accounting for death as a competing risk, the cumulative incidence of IBTR was:

• 5.3% at 1 year

• 12.2% at 2 years

• 18.2% at 3 years

These results indicate that breast cancer cryoablation can be safely applied to a broader patient population than defined by current clinical trial inclusion criteria. The high technical success rate and manageable AE profile support cryoablation as a viable alternative to surgery, particularly for patients who are poor surgical candidates due to age, comorbidities, or other factors.

This study demonstrates that breast cancer cryoablation could be safely and effectively extended to even more patients who previously could not participate in clinical trials. This is very important for patients who are poor surgical candidates, providing them with a minimally invasive option with good outcomes. Breast cancer cryoablation is a safe surgical alternative with favorable outcomes for select patients with unfavorable characteristics.

Reference:

Oueidat, K., Baird, G. L., Barclay-White, B., Kozlowski, K., Plaza, M. J., Aoun, H., Tomkovich, K., Littrup, P. J., Pigg, N., & Ward, R. C. (2024). Cryoablation of primary breast cancer in patients ineligible for clinical trials: A multiinstitutional study. AJR. American Journal of Roentgenology. https://doi.org/10.2214/ajr.24.31392