STATE OF THE ART AND FUTURE PERSPECTIVES

Many studies have demonstrated that cryoablation represents a useful ablation method for patients with breast cancer, being a well-tolerated procedure that permits to obtain complete tumor necrosis in a high percentage of cases. However, robust evidence is lacking on long-term benefits of its use in the different clinical scenarios. Well designed randomized trials are needed to better elucidate the role of cryoablation in multimodality treatment of breast cancer. Overall, the literature data are heterogeneous, as highlighted in a recent systematic review from Lanza et al who reported a variable local tumor control ranging from 19% to 95%.8 Cryoablation may represent a valid technique for local treatment of patients who are unsuitable for, or refuse surgery. Moreover, it should be taken into account as a method of primary tumor ablation in patients presenting with distant metastases, who may benefit of a percutaneous procedure instead of surgical removal of the tumor, given the systemic diffusion of the neoplastic disease and the doubted utility associated to lumpectomy in those situations.

Cryoablation as an alternative to surgery in patients with early breast cancer is the most interesting aspect, because it may represent a conceptual shift toward a minimally invasive treatment. In spite of encouraging results, to date no studies have demonstrated that cryoablation is equal to breast-conserving surgery in terms of local control, disease-free survival, or overall survival. Interestingly, the ongoing trials are evaluating cryoablation as curative treatment in a highly selected patients, namely those older than 50 years having low risk breast cancer no larger than 15 mm. While waiting for the results of those trials, breast-conserving surgery must be considered as the treatment of choice for patients with early breast cancer.


Continue Reading

Studies are also needed regarding timing and modalities of imaging follow-up after cryoablation, because the importance to early detect local recurrences after tumor ablation cannot be overemphasized.

Effects of cryoablation on immune system and possible synergic effects with systemic therapies are open and fascinating fields that deserve further attention. In fact, immune therapy has recently emerged as a useful treatment for various solid tumors. Currently, immune strategies include the use of drugs that modulate key T cell inhibitory checkpoints and vaccines. In particular, checkpoint blockade along with other treatments such as systemic therapies and localized therapy including tumor cryoablation seems to be a promising strategy in the treatment of breast cancer.

Author contributions

1. Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data: Claudio Pusceddu, Panagiotis Paliogiannis, Giuseppe Nigri, Alessandro Fancellu.

2. Drafting the article or revising it critically for important intellectual content: Claudio Pusceddu, Panagiotis Paliogiannis, Giuseppe Nigri, Alessandro Fancellu.

3. Final approval of the version to be published: Claudio Pusceddu, Panagiotis Paliogiannis, Giuseppe Nigri, Alessandro Fancellu.

4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Claudio Pusceddu, Panagiotis Paliogiannis, Giuseppe Nigri, Alessandro Fancellu.

Disclosure

The authors report no conflicts of interest in this work.


Claudio Pusceddu,1 Panagiotis Paliogiannis,2 Giuseppe Nigri,3 Alessandro Fancellu4

1Division of Interventional Radiology, Department of Oncologic Radiology, Businco Hospital, Cagliari, Italy; 2Unit of Experimental Pathology and Oncology, Department of Medical Surgical and Experimental Sciences, University of Sassari, Sassari, Italy; 3Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, St. Andrea University Hospital, Rome, Italy; 4Unit of General Surgery 2 – Clinica Chirurgica, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy

Correspondence: Alessandro Fancellu
University of Sassari, Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2 – Clinica Chirurgica, V.le San Pietro 43, Sassari 07100, Italy
Tel +39 079 228432
Fax +39 079 228394
Email [email protected]


References

1. Cazzato RL, Garnon J, Ramamurthy N, et al. Percutaneous image-guided cryoablation: current applications and results in the oncologic field. Med Oncol. 2016;33:140. doi:10.1007/s12032-016-0848-3

2. Pusceddu C, Melis L, Ballicu N, et al. Percutaneous microwave ablation under CT guidance for hepatocellular carcinoma: a single institutional experience. J Gastrointest Cancer. 2018;49(3):295–301. doi:10.1007/s12029-017-9951-8

3. Mahnken AH, König AM, Figiel JH. Current Technique and Application of Percutaneous Cryotherapy. Rofo. 2018;190:836–846. doi:10.1055/a-0598-5134

4. Pusceddu C, Melis L, Sotgia B, Guerzoni D, Porcu A, Fancellu A. Usefulness of percutaneous microwave ablation for large non-small cell lung cancer: apreliminary report. Oncol Lett. 2019;18:659–666. doi:10.3892/ol.2019.10375

5. Zhao Z, Wu F. Minimally-invasive thermal ablation of early-stage breast cancer: a systematic review. Eur J Surg Oncol. 2010;36:1149–1155. doi:10.1016/j.ejso.2010.09.012

6. Machida Y, Shimauchi A, Igarashi T, Fukuma E. MRI findings after cryoablation of primary breast cancer without surgical resection. Acad Radiol. 2019;26:744–751. doi:10.1016/j.acra.2018.07.012

7. Mauri G, Sconfienza LM, Pescatori LC, et al. Technical success, technique efficacy and complications of minimally-invasive imaging-guided percutaneous ablation procedures of breast cancer: A systematic review and meta-analysis. Eur Radiol. 2017;27(8):3199–3210. doi:10.1007/s00330-016-4668-9

8. Lanza E, Palussiere J, Buy X, et al. Percutaneous image-guided cryoablation of breast cancer: a systematic review. J Vasc Interv Radiol. 2015;26:1652–1657. doi:10.1016/j.jvir.2015.07.020

9. Nguyen T, Hattery E, Khatri VP. Radiofrequency ablation and breast cancer: a review. Gland Surg. 2014;3:128–135. doi:10.3978/j.issn.2227-684X.2014.03.05

10. Rui J, Tatsutani KN, Dahiya R, Rubinsky B. Effect of thermal variables on human breast cancer in cryosurgery. Breast Cancer Res Treat. 1999;53:185–192. doi:10.1023/A:1006182618414

11. Pusceddu C, Melis L, Sotgia B, Fancellu A, Meloni GB. Computed tomography-guided cryoablation of local recurrence after primary resection of pancreatic adenocarcinoma. Clin Pract. 2015;5:741. doi:10.4081/cp.2015.741

12. Pusceddu C, Sotgia B, Amucano G, et al. Breast cryoablation in patients with bone metastatic breast cancer. J Vasc Interv Radiol. 2014;25:1225–1232. doi:10.1016/j.jvir.2014.05.001

13. Chu KF, Dupuy DE. Thermal ablation of tumors: biological mechanisms and advances in therapy. Nat Rev Cancer. 2014;14:199–208. doi:10.1038/nrc3672

14. Tafra L, Smith SJ, Woodward JE, Fernandez KL, Sawyer KT, Grenko RT. Pilot trial of cryoprobe-assisted breast-conserving surgery for small ultrasound-visible cancers. Ann Surg Oncol. 2003;10:1018–1024. doi:10.1245/aso.2003.04.002

15. Tarkowski R, Rzaca M. Cryosurgery in the treatment of women with breast cancer—a review. Gland Surg. 2014;3:88–89. doi:10.3978/j.issn.2227-684X.2014.03.04

16. Morin J, Traore A, Dionne G, et al. Magnetic resonance guided percutaneous cryosurgery of breast carcinoma: technique and early clinical results. Can J Surg. 2004;47:347–351.

17. Pusztaszeri M, Vlastos G, Kinkel K, et al. Histopathological study of breast cancer and normal breast tissue after magnetic resonance-guided cryotherapy ablation. Cryobiology. 2007;55:44–51. doi:10.1016/j.cryobiol.2007.05.002

18. Littrup PJ, Jallad B, Chandiwala-Mody P, D’Agostini M, Adam BA, Bouwman D. Cryotherapy for breast cancer: a feasibility study without excision. J Vasc Interv Radiol. 2009;20:1329–1341. doi:10.1016/j.jvir.2009.06.029

19. Chandra D, Jahangir A, Cornelis F, et al. Cryoablation and Meriva have strong therapeutic effect on triple-negative breast cancer. Oncoimmunology. 2015;5:e1049802. doi:10.1080/2162402X.2015.1049802

20. Pusceddu C, Melis L, Ballicu N, et al. Cryoablation of primary breast cancer in patients with metastatic disease: considerations arising from a single-centre data analysis. Biomed Res Int. 2017;2017:3839012. doi:10.1155/2017/3839012

21. Fleming MM, Holbrook AI, Newell MS. Update on image-guided percutaneous ablation of breast cancer. AJR. 2017;208:267–274. doi:10.2214/AJR.16.16984

22. Fancellu A, Sanna V, Sedda ML, et al. Benefits of organized mammographic screening programs in women aged 50 to 69 years: a surgical perspective. Clin Breast Cancer. 2019. doi:10.1016/j.clbc.2019.04.013

23. Fancellu A, Sanna V, Cottu P, et al. Mastectomy patterns, but not rates, are changing in the treatment of early breast cancer. Experience of a single European institution on 2315 consecutive patients. Breast. 2018;39:1–7. doi:10.1016/j.breast.2018.02.003

24. Fancellu A, Cottu P, Feo CF, et al. Sentinel node biopsy in early breast cancer: lessons learned from more than 1000 cases at a single institution. Tumori. 2012;98:413–420. doi:10.1700/1146.12633

25. Gambardella C, Clarizia G, Patrone R, et al. Advanced hemostasis in axillary lymph node dissection for locally advanced breast cancer: new technology devices compared in the prevention of seroma formation. BMC Surg. 2019;18(Suppl 1):125. doi:10.1186/s12893-018-0454-8

26. Niu L, Wu B, Xu K. Cryosurgery for breast fibroadenomas. Gland Surg. 2012;1:128–131. doi:10.3978/j.issn.2227-684X.2012.08.02

27. Kaufman CS, Littrup PJ, Freeman-Gibb LA, et al. Office-based cryoablation of breast fibroadenomas with long-term follow-up. Breast J. 2005;11:344–350. doi:10.1111/j.1075-122X.2005.21700.x

28. Littrup PJ, Freeman-Gibb L, Andea A, et al. Cryotherapy for breast fibroadenomas. Radiology. 2005;234:63–72. doi:10.1148/radiol.2341030931

29. Paepke S, Metz S, Brea Salvago A, Ohlinger R. Benign breast tumours – diagnosis and management. Breast Care (Basel). 2018;13:403–412. doi:10.1159/000495919

30. Sabel MS, Kaufman CS, Whitworth P, et al. Cryoablation of early-stage breast cancer: work-in-progress report of a multi-institutional trial. Ann Surg Oncol. 2004;11:542–549. doi:10.1245/ASO.2004.08.003

31. Poplack SP, Levine GM, Henry L, et al. A pilot study of ultrasound-guided cryoablation of invasive ductal carcinomas up to 15 mm with MRI follow-up and subsequent surgical resection. AJR Am J Roentgenol. 2015;204:1100–1108. doi:10.2214/AJR.13.12325

32. Simmons RM, Ballman KV, Cox C, et al.; ACOSOG investigators. A Phase II Trial Exploring the Success of Cryoablation Therapy in the Treatment of Invasive Breast Carcinoma: results from ACOSOG (Alliance) Z1072. Ann Surg Oncol. 2016;23:2438–2445. doi:10.1245/s10434-016-5275-3

33. Gajda MR, Mireskandari M, Baltzer PA, et al. Breast pathology after cryotherapy. Histological regression of breast cancer after cryotherapy. Pol J Pathol. 2014;65:20–28. doi:10.5114/pjp.2014.42665

34. Manenti G, Scarano AL, Pistolese CA, et al. Subclinical breast cancer: minimally invasive approaches. Our experience with percutaneous radiofrequency ablation vs. cryotherapy. Breast Care (Basel). 2013;8:356–360. doi:10.1159/000355707

35. Cazzato RL, de Lara CT, Buy X, et al. Single-centre experience with percutaneous cryoablation of breast cancer in 23 consecutive non-surgical patients. Cardiovasc Intervent Radiol. 2015;38:1237–1243. doi:10.1007/s00270-015-1181-5

36. Cryoablation of Small Breast Tumors in Early Stage Breast Cancer (FROST). Available from: https://clinicaltrials.gov/ct2/show/NCT01992250. Accessed July 20, 2019.

37. Cryoablation of Low Risk Small Breast Cancer- Ice3 Trial. Available from: https://clinicaltrials.gov/ct2/show/NCT02200705. Accessed July 20, 2019.

38. Pfleiderer SO, Marx C, Camara O, Gajda M, Kaiser WA. Ultrasound-guided, percutaneous cryotherapy of small (< or = 15 mm) breast cancers. Invest Radiol. 2005;40:472–477. doi:10.1097/01.rli.0000166935.56971.ff

39. Beji H, Pilleul F, Picard R, et al. Percutaneous cryoablation of breast tumors in patients with stable metastatic breast cancer: safety, feasibility and efficacy. Br J Radiol. 2018;91(1083):20170500. doi:10.1259/bjr.20170500

40. Fancellu A, Soro D, Castiglia P, et al. Usefulness of magnetic resonance in patients with invasive cancer eligible for breast conservation: a comparative study. Clin Breast Cancer. 2014;14:114–121. doi:10.1016/j.clbc.2013.10.002

41. Fancellu A, Turner RM, Dixon JM, Pinna A, Cottu P, Houssami N. Meta-analysis of the effect of preoperative breast MRI on the surgical management of ducal carcinoma in situ. Br J Surg. 2015;102:883–893. doi:10.1002/bjs.9797

42. Pediconi F, Marzocca F, Cavallo Marincola B, Napoli A. MRI-guided treatment in the breast. J Magn Reson Imaging. 2018;48:1479–1488. doi:10.1002/jmri.26282

43. Sabel MS, Nehs MA, Su GK, et al. Immunologic response to cryoablation of breast cancer. Breast Cancer Res Treat. 2005;90:97–104. doi:10.1007/s10549-004-3289-1

44. Abdo J, Cornell DL, Mittal SK, Agrawal DK. Immunotherapy plus cryotherapy: potential augmented abscopal effect for advanced cancers. Front Oncol. 2018;8:85. doi:10.3389/fonc.2018.00085

45. Keisari Y. Tumor abolition and antitumor immunostimulation by physico-chemical tumor ablation. Front Biosci. 2017;22:310–347. doi:10.2741/4487

46. Sidana A. Cancer immunotherapy using tumor cryoablation. Immunotherapy. 2014;6:85–93. doi:10.2217/imt.13.151

47. McArthur HL, Diab A, Page DB, et al. A pilot study of preoperative single-dose ipilimumab and/or cryoablation in women with early stage breast cancer with comprehensive immune profiling. Clin Cancer Res. 2016;22:5729–5737. doi:10.1158/1078-0432.CCR-16-0190

48. Liang S, Niu L, Xu K, et al. Tumor cryoablation in combination with natural killer cells therapy and Herceptin in patients with HER2-overexpressing recurrent breast cancer. Mol Immunol. 2017;92:45–53. doi:10.1016/j.molimm.2017.10.003

49. Ye P, Yin H, Gu X, et al. Improved synergetic therapy efficiency of cryoablation and nanoparticles for MCF-7 breast cancer. Nanomedicine (Lond). 2018;13:1889–1903. doi:10.2217/nnm-2018-0168

Source: Breast Cancer: Targets and Therapy.
Originally published October 10, 2019.

READ FULL ARTICLE Curated publisher From Dovepress