Cryoablation of Primary Breast Cancer in Patients with Metastatic Disease: Considerations Arising from a Single-Centre Data Analysis

Abstract

Background: Patients presenting with stage IV breast cancer might benefit by removal of the primary tumor. We report our experience with CT-guided cryoablation of the primary tumor, with the aim of evaluating its role in this subgroup of patients.

Patients and methods: Data of 35 patients with mean age of 58 years with breast cancer at stage IV submitted to CT-guided cryoablation of the primary tumor between 2010 and 2016 were prospectively evaluated. All patients, except three, were preoperatively and postoperatively evaluated with breast MRI to assess the extent of tumor necrosis. Retreatment was performed in case of incomplete ablation.

Results: Mean tumor size was 3.02 ± 1.4 cm. Six patients had multicentric disease. Complete tumor necrosis was 85.7% and 100% at 2-month and 6-month follow-up, respectively, as 5 patients with tumors > 3 cm required a redo cryoablation. No patient developed major complications. Minor side effects occurred in 30 patients (82%). All patients were discharged the same day of the procedure. During a mean follow-up of 46 months (range 3-84), 7 patients (20%) experienced local recurrences that were treated with redo cryoablation, and 7 (20%) died for disease progression.

Conclusions: Our results suggest that cryoablation of the primary tumor is safe and effective in the treatment of patients presenting with stage IV breast cancer.

Figure 1

A 50-year-old woman was diagnosed as having invasive ductal carcinoma and distant metastases. Axial contrast-enhanced T1-weighted fat suppression MR image showed the primary breast cancer located in the external quadrant of the left breast measuring 27 mm in its major diameter (arrow) (a). She was submitted to CT-guided cryoablation of the breast tumor under local anesthesia and conscious sedation. We used three cryoprobes along with one thermocouple for temperature monitoring (b). Axial contrast-enhanced T1-weighted fat suppression image 2 months after the procedure showed complete ablation with a large nonenhanced area, due to tissue necrosis, surrounded by a ring of enhanced tissue compatible with granulation tissue in the proliferative phase (arrow) (c).

Figure 2

CT scan of an 81-year-old woman using the mediastinal window setting showed a primary breast cancer of the right breast (arrow) infiltrating the major pectoralis muscle (double arrow) (a). The patient received cryoablation of the primary tumor. CT scan obtained at the end of the cryoablation procedure showed the presence of a homogeneous area of low density because of the iceball (arrow), which encompassed the tumor (b). The same patient developed a contralateral breast cancer after 13 months. T2-weighted MR image showed a breast tumor in the left breast (arrow) (c). Contrast-enhanced T1-weighted fat suppression MR image showed the complete ablation of the cancer of the right breast and the contralateral tumor (circle and arrow, resp.) (d). CT-guided cryoablation of the left breast cancer using two cryoprobes (e).

Figure 3

A 70-year-old woman having a ductal breast carcinoma of the right breast and a painful osteolytic metastasis of the sternal bone (arrow) (a). A simultaneous cryoablation of the primary breast tumor (double arrow) and of the bone metastasis was performed (arrow) (b, c).

Figure 4

Kaplan–Meier curve for time to local recurrence in the 35 patients of the study cohort.