What is Cryotherapy?
Traditionally the only way to remove a tumor was through surgery, an invasive procedure for the patient. However, technological advancements in the last few decades have provided a whole host of new approaches, and one of those exciting tools is cryoablation.
Cryoablation provides a safe, effective, and minimally invasive approach to destroy tumors of the breast, lung, kidney, bone, liver and is one method for providing palliative care.
What is Cryoablation Treatment for Breast?
Cryoablation is a minimally invasive procedure that uses extreme cold temperatures to destroy (ablate) benign or malignant tumors. The tissues targeted for destruction are visualized using imaging guidance such as ultrasound or computed tomography (CT). An extremely cold freezing agent (liquid nitrogen, liquid nitrous oxide, or compressed argon gas) is administered through a thin needle called a cryoprobe in a closed-loop system, freezing and destroying the abnormal tissue.
During a cryoablation procedure, one or more cryoprobes are inserted into the affected area after anesthesia or conscious sedation has been administered. Ultrasound or CT imaging scans are used to guide placement and ensure that the cryoprobe tip is properly positioned. The freezing agent is circulated within the cryoprobe once it has been inserted, creating an ice ball around the targeted tissue. CT scans verify that the ice ball covers the entire tumor as well as a margin of healthy tissue to ensure the area was completely treated. Once this has been accomplished, the cryoprobe is warmed by the cryoablation system and safely extracted from the patient.
When is Cryoablation an option?
Cryoablation can effectively treat a wide range of benign and malignant tumors, including cancers of the lung, kidney, breast, bone, liver, and some others. The ability to treat the tumor will depend on a number of factors including the type of tumor, location, size, and how well the tumor can be seen under image-guidance.
Metastatic cancers (where the cancer spreads to another part of the body) may be treated with cryoablation to alleviate pain and other symptoms. When a patient is unsuitable for surgical removal of a tumor due to various reasons including advanced age, or other comorbidities, this type of treatment is often recommended.
How long does a Cryoablation Procedure take?
A typical percutaneous cryoablation procedure can take about 1 1/2 to 2 hours. Depending on the type of tumor and the location, such as in the case of treating breast tumors, that time can be shortened to 15-45 minutes.
What are the risks of Cryoablation?
Cryoablation therapy is generally very safe, and the risks involved are generally lower than compared to surgery. There is a small risk of bleeding, infection, and accidental damage to nearby, healthy organs, as with all medical procedures.
What happens to a Tumor after Cryoablation?
With a combination of effects, lethal ice destroys tumors. Freezing basically dries out cells and causes them irreparable damage. As a result, blood flow to the tumor is cut off. The necrotic tissue is slowly absorbed by phagocytic activity of the inflammatory cells. Phagocytosis is a process in which inflammatory cells such as macrophages, neutrophils, eosinophils, and mast cells engulf and remove unwanted cells. Eventually the necrotic tissue is replaced by a fibrous, collagenous scar over the next few weeks and even months.
How is Cryoablation Tolerated by Patients?
The body typically tolerates freezing well because it is a natural process. A cryoablation procedure usually involves less pain and shorter recovery times than heat-based treatments like radiofrequency ablation. An additional advantage of cryoablation is that it can be repeated if required.
Cryoablation for Breast Tumors
Cryoablation therapy has been increasingly used to treat breast tumors over the last two decades and is a new hope in breast care.
Clinical trials support the use of cryoablation to treat benign breast tumors called fibroadenomas. The American Association of Breast Surgeons considers it “… a successful option for the resolution of fibroadenomas without surgical excision.”
For the treatment of breast cancer, there are exciting cryoablation studies underway in the USA and clinical experience globally supports its use. One such trial is the landmark ICE3 study. This is the largest controlled multi-site clinical trial ever performed for liquid nitrogen (LN2)-based cryoablation of small, low-risk, early-stage breast tumors without the need for surgical excision afterwards.
The ICE3 trial began in 2014, with 206 patients enrolled and treated with a duration procedure of 20-40 minutes, the ICE3 trial has shown promising interim results. At a mean of 34.83 months following treatment with the cryoablation system, ProSense®, only 2.06% (4 patients out of the 194 followed from the 206 enrolled) experienced cancer recurrence.
