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Pushing the Envelope: Cryoablation for the Breast Surgeon

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Every year, members of the American Society of Breast Surgeons (ASBrS) push the envelope further on innovation and techniques to improve care for our patients with breast cancer. Many novel ideas and studies to advance breast surgery were presented at this year’s annual symposium in Boston, which brought together more than 1,600 members from our society. For me, one of these studies in particular stands out. 

While cryoablation, or freezing tumors, has been well-established for treatment of some cancers, such as lung and kidney, it is just beginning to gain traction among breast surgeons. The procedure is described as simple, office-based and with minimal pain. Patient-selection, tumor selection, and operator skill are all critical components to ensuring success of treatment.

During a pre-course session titled “Cryotherapy: An Introductory Course for the Ultrasound-Experienced Surgeon” at this year’s symposium,” those of us who participated learned more about the procedure from several surgeons who have been pioneers in cryoablation for breast cancer. Following a thorough didactic session that included background data, mechanism of action of cryotherapy and technique of cryoprobe placement, participants had a hands-on course learning how to position the probe accurately in simulation models, as well as how to create the ideal-sized ice ball used for treatment of breast cancers. Such hands-on courses at the annual ASBrS have been instrumental in enabling breast surgeons to acquire new skills and techniques.

After the pre-course session, Dr. Rache M. Simmons, Weiskopf Professor of Surgical Oncology and Associate Dean at Weill Cornell Medical College—New York Presbyterian Hospital, gave a talk at the ASBrS Surgical Innovation Forum titled “Cryoablation for the Breast Surgeon,” during which she delineated the cryoablation technique, most-current safety and efficacy data for cryoablation for breast cancer, and also future studies. 

In the pivotal phase II ACOSOG (Alliance) Z1072 trial, for which Dr. Simmons served as principal investigator, patients with clinical stage I breast cancer underwent cryoablation, followed by standard-of-care surgical excision within 28 days of ablation. Of 86 patients from 19 enrolling centers, there was 100% ablation of unifocal tumors <1cm in size at final surgical pathology. Six patients had residual tumor found at time of surgery, thought to be due to incidental multifocal tumors or aberrant probe placement.

 Interim data from the Ice3 prospective trial of cryoablation alone without surgical intervention also was presented. In this multicenter, non-randomized trial, 194 patients with mean tumor size of 8.1mm underwent cryoablation and were then followed for mean 34.8 months. Ipsilateral tumor recurrence occurred in 2.1% of patients with mean time to recurrence of 43.1 months.

Emerging data is continuing to show efficacy and safety of cryoablation for select, small breast tumors, and on-going trials are evaluating the application of cryotherapy in the neoadjuvant setting. Currently, multiple commercial cryotherapy companies have received FDA approval for treatment of breast cancers. I look forward to long-term follow-up of patients undergoing cryotherapy treatment and to learn what more we, as breast surgeons, can do to push the envelope even further.

Dr. Kapoor has no conflicts of interest to report.

Illustration by Jennifer Bogartz

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