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.

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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.


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]


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

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