European Conference on Interventional Oncology
ECIO countries

April 28 - May 1 | Palma de Mallorca, ES

April 28 - May 1 | Palma de Mallorca, ES

April 28 - May 1 | Palma de Mallorca, ES

April 28 - May 1 | Palma de Mallorca, ES

April 28 - May 1 | Palma de Mallorca, ES

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ProgrammeSneak peeksCryoablation: a promising technique for the treatment of breast cancer

Cryoablation: a promising technique for the treatment of breast cancer

 

Three reasons why you cannot miss my lecture

  1. You will learn why cryoablation is the outstanding procedure among the different thermal ablation techniques for the treatment of breast carcinomas
  2. You will understand for which patients cryoablation is a suitable treatment option
  3. You will learn about our results in the management of early breast cancer with cryoablation

Dr. Ylenia Navarro Monforte
Speaker bio
 

Add this session to your calendar!

Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death in women worldwide [1]. Surgical treatment has changed significantly in recent years, with breast-conserving surgery being the preferred treatment for early-stage invasive breast cancer [2]. Nowadays, percutaneous techniques are also beginning to be considered as an alternative due to their benefits. Among the different thermal ablation techniques, cryoablation has the advantage of not requiring general anesthesia. Also there are no indication limits regarding skin or the pectoral fascia and big lesions can be treated.

Our preferred treatment for the management of elderly patients

This procedure can be a good treatment option in patients unsuitable for surgery because of age or comorbilities. In our hospital, we have treated over 160 patients with cryoablation as an alternative to surgery, achieving a 93% of local control. In this cases, it is very important to combine the ablation of the tumour with endocrine therapy, to ensure a good long-term response [3].

A near future: non-surgical management of early breast cancer

Cryoablation can also be considered in early breast cancer. Thanks to screening programs and better equipment, now we can detect very small tumors, candidates for breast-conserving surgery. In 2004, Sabel et al published a study in which 27 invasive ductal carcinoma (IDC) less than 10 mm were treated with cryoablation. Then surgery was perfomed, with 100% success rate, meaning no invasive carcinoma left in the surgical specimen [4]. In 2015 and 2016 there was a similar study by Poplack et al [5] and by Acosog [6], with very promising results. In 2014 started the Ice3, a multicentric trial similar to the studies mentioned above, avoiding surgery after cryoablation. Final results are expected by december 2024, with no recurrence rate so far between 95 and 99% [7].

Considering this data, in April 2021 we started a trial in our hospital in this group of patients too [8]. We treat low risk breast carcinoma with cryoablation and, after surgery, our aim is to proof that there’s no infiltrating tumour left in the surgical specimen. Our results until April 2023 are the following. We have treated 52 cases of IDC less than 20 mm: 32 pure infiltrating carcinoma and 20 mixed, meaning intraductal component associated. After cryoablation, in the surgical specimen, there were no invasive component left in 100% of the cases of pure carcinoma, and in 80% of the mixed carcinomas. Overall, we had a success rate of a 92%, and all the lesions had tumor-free margins [9].

Cryoablation is also a very safe and well tolerated procedure. None of our patients had any complications.

 

Ylenia Navarro Monforte

La Paz University Hospital, Madrid/ES

Dr. Ylenia Navarro Monforte is a senior consultant in Breast Radiology at La Paz University Hospital in Madrid (Spain), member of the Multidisciplinary Breast Pathology Unit. She is active in medical education and teaching collaborator of the Autonomous University of Madrid. Member of the Spanish Society of Medical Radiology (SERAM) and the Spanish Society of Breast Imaging (SEDIM). Dr Ylenia and her collegues in Breast Radiology of La Paz Hospital are experts in the treatment of breast cancer with cryoablation, achieving excellent results since 2019. They are very interested in developing new indications of cryoablation in breast lesions, being pioneers worldwide in managing other pathologies using this technique such as skin fistulas in chronic mastitis. Dr Ylenia is also carrying out an important study together with the Breast Unit and The Health Research Institute of La Paz University Hospital (IdiPAZ) about immunological responses to breast cancer cryoablation, implications for prognosis, abscopal effects against metastases and immunotherapy.

 

References

  1. Sung H., Ferlay J., Siegel R.L., Laversanne M., Soerjomataram I., Jemal A. et al.
    Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.
  2. Apantaku LM. Breast-conserving surgery for breast cancer. Am Fam Physician. 2002 Dec 15;66(12):2271-8. PMID: 12507165.
  3. Goldaracena, J.O., Alvarez, C., Chicote, V.C., Méndez, J.I., Navarro, M., Alonso, D.G., Monforte, Y.N., de Bustamante Durbán, T.D., Martínez, F.G., Pineda, E.Y., Galindo, A.L., Aldeguer, L.F., Palacios, E.M., Auñón, P.Z., Marín, V.M., Gregorio, L.Y., Hernáez, D.H., & Moll, G.G. (2023). P266 Cryoablation with endocrine therapy for clinical stage I/II, ER+, HER2- invasive breast cancer in patients with omission of surgical axillary staging. The Breast.
  4. Sabel MS, Kaufman CS, Whitworth P, Chang H, Stocks LH, Simmons R, et al. Cryoablation of early-stage breast cancer: Work-in-progress report of a multi-institutional trial. Ann Surg Oncol. 2004;11:542—9.
  5. Poplack SP, Levine GM, Henry L, Wells WA, Heinemann FS, Hanna CM, et al. A pilot study of ultrasound-guided cryoa[1]blation of invasive ductal carcinomas up to 15 mm with MRI follow-up and subsequent surgical resection. Am J Roentgenol. 2015;204:1100—8.
  6. Simmons RM, Ballman KV, Cox C, Carp N, Sabol J, Hwang RF, et al. A phase II trial exploring the success of cryoabla[1]tion therapy in the treatment of invasive breast carcinoma: Results from ACOSOG (Alliance) Z1072. Ann Surg Oncol. 2016;23: 2438—45.
  7. Fine RE, Gilmore RC, Dietz JR, Boolbol SK, Berry MP, Han LK, et al. Cryoablation without excision for low-risk early[1]stage breast cancer: 3-year interim analysis of ipsolateral breast tumor recurrence in the ice3 trial. Ann Surg Oncol. 2021;28:5525—34.
  8. Roca Navarro MJ, Garrido Alonso D, Navarro Monforte Y, García Martínez F, Díaz de Bustamante Durbán T, Córdoba Chicote MV, et al. Efficacy of ultrasound-guided cryoablation in treating low-risk breast cancer. Radiología. 2022 Jun; https://doi.org/10.1016/j.rxeng.2023.03.002
  9. M.ªJ. Roca Navarro; P. Zamora Auñón; Y. Navarro; D. Garrido¹ M.ªV. Córdoba; T. Díaz de Bustamante; F. García; J. M.ª. Oliver; L. Yébenes; C. Martí; J.I. Sánchez; E. Moreno; L. Frías; A. Loayza Galindo, A. Berjón; M. Meléndez; C. Martín, L. Miralles; C. Escabias; Y Abadi; E. York Pineda, G. Garzón. D. Hardisson; A Hernández; C. Casado; V. Martínez, S.Zarbakhsh; J.Gómez. Preoperative cryoablation in 52 HER2- luminal invasive ductal carcinomas ≤ 2CM. Analysis of the tumor specimen. Poster presented at San Antonio Breast Cancer Symposium; December 5-9, 2023; San Antonio.