Peter Littrup, M.D.
The study, “Cryotherapy for a Spectrum of Breast Cancer: US and CT-guidance,” was presented at the Society of Interventional Radiology’s 35th annual Scientific Meeting in Tampa, Fla. It details how researchers successfully froze breast cancer in patients who refused surgery. The women did not need surgery to ensure the tumors were destroyed.
“Minimally-invasive cryotherapy opens the door for a potential new treatment for breast cancer and needs to be further tested,” said Peter J. Littrup, M.D., professor of Radiology, Urology and Radiation Oncology at the School of Medicine, and vice chair for Radiology Research and director of Interventional Radiology at the Karmanos Cancer Institute. “When used for local control and/or potential cure of breast cancer, it provided safe and effective breast conservation with minimal discomfort for a group of women who refused invasive surgery or had a local recurrence and needed additional management.
“This is the first reported study of successfully freezing breast cancer without having to undergo surgery afterward to prove that it was completely treated,” he said.
In the 13-patient study, researchers used several needle-like cryoprobes that were evenly spaced and inserted through the skin to deliver extremely cold gas directly to the tumor to freeze it. This technique has been used for many years by surgeons in the operating room. In the last few years, however, the needles have become small enough to be used by interventional radiologists through a small nick in the skin, without the need for surgery. The “ice ball” that is created around the needle grows in size and destroys the frozen tumor cells.
Biopsies were performed at the margins of the cryotherapy site immediately after the procedure. Follow-up inspections at those cryotherapy sites showed no cancer present. No localized treatment recurrences were seen for up to five years in the study, no significant complications were noted and women were pleased with the cosmetic outcomes, Dr. Littrup noted.
Major benefits of cryotherapy are its superb visualization of the ice treatment zone during the procedure, its low pain profile in an outpatient setting and its excellent healing with minimal scar, said Dr. Littrup. Breast imaging has significantly advanced by accurate improvements in breast magnetic resonance imaging, allowing for excellent treatment planning of tumor size and extent within the breast, as well as showing zones of destruction thoroughly covering the tumor after cryotherapy.
This potential treatment method holds widespread promise for the nearly 200,000 women who are diagnosed with breast cancer annually in the United States. For these women, as well as the thousands of men diagnosed each year, breast cancer treatments can be highly effective but often require invasive treatment options such as surgery and chemotherapy.
Surgery offers the best chance for a cure. Until long-term data is available, interventional treatments -- such as cryotherapy, thermal ablation and laser therapy -- are reserved for women who cannot have or have refused surgery.
Cryotechnology promises to be more MR-compatible, Dr. Littrup said, and would also allow accurate targeting of more difficult-to-see breast tumors.
Larger studies in multiple centers needs to be done following these basic cryobiology principles of sufficient lethal temperatures generated by multiple cryoprobes spaced evenly throughout a breast cancer region.
“With recent developments of powerful new cryotechnology, multiple directions for breast cryotherapy can be pursued, including translating the current, somewhat challenging, procedure done with ultrasound and/or CT guidance to a more consistent and reproducible MR-guided approach,” Dr. Littrup said.
The study was written by Dr. Littrup, M.D.; Monica D’Agostini, an undergraduate student who volunteered with the Department of Radiology at Karmanos Cancer Institute; Barbara Adam, cryotherapy staff nurse at Karmanos Cancer Institute; and David Bouwman, M.D., professor of Surgery at the School of Medicine and emeritus director of Karmanos’ Alexander J. Walt Breast Center; along with Bassel Jallad, M.D., and Priti Chandiwala-Mody, D.O., residents at the School of Medicine.