Cryoablation Safe for Breast Cancer Patients who are poor surgical candidates: Study

Cryoablation is a minimally invasive treatment to kill cancer cells through extreme cold. While clinical trials have shown this to be effective, highly stringent inclusion criteria exclude those patients whose diseases are potentially treatable. This study evaluated the safety and outcomes of cryoablation in a real-world setting on patients excluded from clinical trials.

This was a retrospective study of women with cryoablation of biopsy-proven unifocal primary breast cancer treated with locally curative intent without surgical excision at seven institutions between January 1, 2000, and August 26, 2021. Adverse events were recorded. Cryoablation procedures were considered to be technically successful when they were not aborted prematurely and intended treatment parameters had been reached with no residual disease on the first imaging follow-up. Follow-up biopsy results were noted, and ipsilateral breast tumor recurrences were identified and classified as true recurrence versus new primary disease. A competing-risk model estimated the cumulative incidence of IBTR accounting for death before IBTR.

• Their median age was 71 years, and a total of 112 patients were studied. Slight AEs occurred in 7 of 112 patients (6.3%). No moderate or major AEs were reported. The technical success rate for cryoablation procedures reached 110 of 112 (98.2%).

• With a median follow-up of 2.0 years, 22 of the 110 patients underwent biopsy for suspicious imaging findings in the ipsilateral breast, which demonstrated benign findings in 9 of the 22 and IBTR in 12 of the 22.

• In total, 12 of the 110 developed IBTR: 7 were cases of true recurrence, while 5 were of new primary disease.

• Of these 12 patients with IBTR, three had prior adjuvant or neoadjuvant treatment.

• Their cumulative incidence of IBTR was 5.3%, 12.2%, and 18.2% at 1, 2, and 3 years, respectively, when accounting for death as a competing risk.

This paper demonstrates that breast cancer cryoablation is a very safe and effective treatment for patients who do not meet the inclusion criteria of clinical trials due to unfavorable characteristics. The high rate of technical success, together with a low severe adverse event rate, underlines the potential for cryoablation to form part of the armamentarium for breast cancer treatment, in particular in patients not suitable for surgery.

In select individuals with unfavorable patient or tumor characteristics, breast cancer cryoablation provides a safe alternative to surgery with good outcomes. These findings may be particularly relevant in patients who are also poor surgical candidates, supporting the broader application of cryoablation beyond the strict criteria of clinical trials.

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