Cryoablation could freeze recurrence in its tracks for patients with breast cancer
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Key takeaways:
- Patients who received cryoablation as treatment for breast cancer had low recurrence rate after 16 months.
- Adverse events included swelling, bruising and potential skin injury due to ice ball.
Yolanda Bryce, MD, still remembers her patient’s shock.
The 79-year-old woman had extensive breast cancer, but she could not undergo surgery due to heart failure. With her options limited, she got a referral to Bryce, an interventional radiologist who founded Memorial Sloan Kettering Cancer Center’s cryoablation program.
Cryoablation kills cancer cells with temperatures below 20°C, administered with a needle hooked up to a generator, which produces an ice ball using argon or nitrogen gas.
The patient’s care team decided to try cryoablation, and it worked.
“She couldn’t understand how it was so simple, how the recovery was so fast, how I got rid of her cancer with just one procedure,” Bryce told Healio, referencing a Memorial Sloan Kettering Cancer Center article the woman inspired in 2022, which noted she had been cancer free for 6 months. “She was just so in awe.”
Bryce has given lectures around the country on cryoablation for about 4 years. They had been sparsely attended at first. Now, the audiences are “packed,” she said.
Bryce hopes the research she and Jolie Jean, MD, of Weill Cornell Medicine, presented at the Society of Interventional Radiology Annual Scientific Meeting can push cryoablation forward even more.
Only 10% of patients with breast cancer who had been treated with cryoablation in their retrospective study had cancer recurrence after at a mean follow-up of 16 months.
Cryoablation could be a primary treatment option for patients with breast cancer who cannot or choose not to undergo surgery.
“We owe it to patients to make sure that they are aware of their options, and they have another choice than just something that is like putting a Band-Aid over their cancer just because they’re not surgical candidates or they don’t want surgery,” Bryce said. .“It doesn't make them less than. They deserve to get the best care that is available.”
Finding another viable option
Surgery is the “gold standard” of care and should be the treatment if viable, Bryce stressed.
However, surgery is not always an option.
Healio previously reported the American Cancer Society estimated 313,510 new breast cancer cases in the U.S. in 2024. Many of those individuals may not be able to undergo surgery due to their age, health status or comorbidities — and some simply choose not to have it, Bryce said.
Traditionally, those patients have received either systemic therapy or radiation instead, but those therapies have efficacy issues.
“Tumors stop responding to hormone therapy in about 18 to 24 months, give or take,” Bryce said.
“If a patient lives long enough, uniformly, they will outlast the effects of the hormone therapy,” she added. “Some patients have been treated also with radiation. That has less of an efficacy — much less. The [disease] control rate is very low,” — 45% to 57% based on the research presented.
In their study, Bryce and Jean examined the recurrence rate in 60 patients (mean age, 75 years) who had cryoablation as primary treatment from January 2017 to March 2023. Participants had an average tumor size of 2.5 cm.
Six patients had disease recurrence, and those with poorly differentiated disease had a higher risk (RR = 5.5; 95% CI, 1.12-27.19).
“I was happy that it was 10% and not more,” Bryce said.
“The recurrences always stay in your mind, and sometimes you focus on the negative and you focus on those that did come back,” she added. It just seems like I [had] so many recurrences, but it really wasn't that many. I felt reassured that I am doing good work for these women.”
Cryoablation can cause adverse events.
Breasts typically swell after the procedure. They can also bruise and ooze fluid.
“We use a lot of fluid in the breast to protect the skin against the ice ball,” Bryce said. “All of this clears up really quickly, in like in a week or 2.”
The ice ball causes scar tissue, which can feel like a lump, but is not another tumor, Bryce said.
If the tumor is too close to the nipple, shooting pain can occur as well, but Bryce said that typically resolves in a few months.
The most serious risk occurs if the ice ball touches the skin, which can happen if the tumor is too close to the skin or is larger in size.
“It’s like a freezer burn to the skin,” Bryce said. “In my experience, when the skin has been injured, I send the patients home with Silvadene cream, and they have all healed. There is a potential of really causing injury to the skin, but I’ve never’ seen any published data that it has gone on to be something catastrophic.”
Expanding the use of cryoablation
Despite Bryce’s best efforts, cryoablation continues to be the “new kid on the block” in terms of treatment options, even though it has been around for more than 2 decades.
Bryce noted several reasons why. The FDA has only approved the technique as a treatment for fibroadenoma.
Some forms of insurance do not cover the procedure, although Bryce uses an “innovation code,” which some insurances do accept.
And “people don’t know about [cryoablation],” she said.
She believes that could change though thanks to the ICE3 and FROST trials.
“They’re concentrating on this group of women that have these favorable tumors, and seeing if cryoablation helps them, and if it's effective,” Bryce said.
According to the ICE3 website, 96.91% of eligible patients did not have cancer recurrence as of July 2022.
These trials could help lead to FDA approval, which could allow for cryoablation to be used in less-favorable cancers, which Bryce showed could be possible with results of her study.
“I think the procedure is something that is very easy to put into your institution,” she said. “The simplicity of it lends itself to even an office setting. It’s important to keep in mind that someone who wants to adopt this practice does it in a multidisciplinary space. You still need the medical oncologist, you still need the radiation oncologist, because I do think that, over time, it will be proven that these modalities — cryoablation, radiation and systemic therapy — will work well together similar to how it has been proven to work well together with lumpectomies.”
References:
- Jean J, et al. Abstract 2. Presented at: Society of Interventional Radiology Annual Scientific Meeting; March 23-28; Salt Lake City.
- Memorial Sloan Kettering Cancer Center. When breast cancer surgery isn’t an option, cryoablation can offer hope (press release). Available at: https://www.mskcc.org/news/when-breast-cancer-surgery-isnt-option-cryoablation-can-offer-hope. Published Oct. 14, 2022. Accessed Marh 29, 2024.
- The ICE3 trial – cryoablation of small, low-risk breast cancer. Available at: https://www.icecure-medical.com/resources/ice3-trial/.
For more information:
Yolanda Bryce, MD, can be reached at brycey@mskcc.org.
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Jean J, et al. Abstract 2. Presented at: Society of Interventional Radiology Annual Scientific Meeting; March 23-28; Salt Lake City.
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