a treatment for breast cancer that may also have palliative purposes
Cryoablation is becoming a minimally invasive technique that offers a therapeutic option that does not negatively impact the quality of life or daily life of some breast cancer patients. In this sense, the Infanta Leonor University Hospital in Madrid has begun to apply this technique to the treatment of breast cancer through its radiology service.
Rosa Lorente Ramos, radiologist at the Infanta Leonor University Hospitalexplains to Gaceta Médica the advantages and procedure of cryoablation. “It is a method of destroying lesions by inserting needles that freeze the tumor,” says Lorente, adding that “during the various freezing and thawing phases, direct damage to the cells occurs due to dehydration of the tumor due to the crystallization of water produced by freezing, followed by indirect damage in the form of ischemic infarction of the lesion due to the obliteration of the microcirculation in this area.
Moreover, the radiologist points out that “cryoablation may also cause cell death indirectly and less immediately by stimulating apoptosis and the release of specific antigens that increase the recognition of tumor cells by the immune system, which thus attacks them.”
Select this procedure
Percutaneous ultrasound-guided cryoablation is a method that is performed under local anesthesia and on an outpatient basis, that is: without the need for hospitalization“First, the tumor is located using ultrasound, anesthesia is administered, and then a cryoablation needle is inserted through a small incision in the skin,” explains Lorente. The needle is then held in place for about half an hour, the time it takes to perform several freeze-thaw cycles. In addition, the cold created by the needle also helps make the procedure painless.
“Once the process is complete, the needle is removed, thus completing the procedure, which is completely outpatient. The success of the treatment depends on various factors, such as the rate of freezing, the minimum temperature reached, the holding time and the rate of thawing,” the expert adds.
To decide in which cases this technique should be used, Lorente explains that “in breast cancer, cryoablation with therapeutic intent is used on small, unifocal, infiltrating tumors of low to moderate severity without lymphadenopathy.” Although cryoablation treatment followed by surgical excision has also been tried. However, cryoablation can also be performed palliative intention“either to reduce the size of the lesion or to reduce symptoms such as pain in patients who are not candidates for surgery due to high surgical risk and who are intolerant or unresponsive to other treatments,” he explains.
“In breast cancer, the use of cryoablation for therapeutic purposes is reserved for small, unifocal, low- to moderate-grade infiltrating tumors without lymphadenopathy.”
In this sense, the specialist notes that there is Numerous tests are being conducted in the treatment of breast tumors with cryoablation alone or in combination with other treatments such as monoclonal antibodies. “Perhaps the largest studies of cryoablation as a single treatment for cancers with a low-risk profile and small size are the ICE3 (Cryoablation in Low-Risk Small Breast Cancer Trial) and the FROST (Cryoablation of Small Breast Tumours in Early Breast Cancer) study, which show tumor recurrence rates similar to surgery,” he points out.
84 year old patient
The first patient treated with this procedure at a public hospital in Madrid was an 84-year-old woman, frail, with multiple pathologies and high anesthetic risk factors. The patient had a tumor that did not respond to hormonal treatment. The results were positive: the injury was completely cured.
This woman was chosen after assessment of the multidisciplinary committee on breast tumors hospital center. “The goal is to carry out a global assessment to decide which treatment is most appropriate for each patient, taking into account all the characteristics of the lesion, the type and extent of the tumor, the spread, but above all, the personal characteristics of each patient, taking into account the factors that may increase morbidity in each specific case,” explains Lorente.
In this regard, in the case of older patients, assessment by physicians is very important. oncogeriatricians which take into account the degree of fragility and, therefore, the benefit of different cancer treatments. Thus, the radiologist notes that “in the case of this patient with multiple pathologies, the need for general anesthesia and possible hospitalization increased postoperative complications, such as, for example, the risk of postoperative delirium, an important cause of morbidity.”
Experts agree that cancer cases in older people are usually associated with other pathologies and more problems than in younger patients. This means need for special managementl elderly patient through geriatric assessment. A geriatrician’s assessment of the best treatment options in each case facilitates the decision on the ideal treatment.
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