Cryosurgery of breast cancer

• Published in: Archives of surgery (Chicago. 1960) Vol. 132; no. 1; p. 28
• Main Authors: Staren, E D, Sabel, M S, Gianakakis, L M, Wiener, G A, Hart, V M, Gorski, M, Dowlatshahi, K, Corning, B F, Haklin, M F, Koukoulis, G
• Format: Journal Article
• Language: English
• Published: United States 01-01-1997
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - surgery; Aged; Animals; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - surgery; Cryosurgery - methods; Dogs; Feasibility Studies; Female; Humans; Mammary Neoplasms, Animal - diagnostic imaging; Mammary Neoplasms, Animal - surgery; Mice; Mice, Inbred DBA; Rats; Rats, Sprague-Dawley; Sheep; Ultrasonography
• ISSN: 0004-0010
• DOI: 10.1001/archsurg.1997.01430250030005

To determine the feasibility and efficacy of cryosurgery of breast cancer.
In phase 1, carcinogen-induced mammary adenocarcinomas in 13 Sprague-Dawley rats were treated by cryosurgery and were then examined for histopathologic change. In phase 2, transplantable mammary adenocarcinomas in 50 DBA/IJ mice were treated by cryosurgery to determine the effect of varying tumor temperatures, and duration and number of freeze-thaw cycles on tumor viability. In phase 3, 2- to 3-cm ultrasound-monitored cryolesions were formed in the breasts of 4 dogs and 4 sheep. These animals were followed up for procedure-related complications; the histopathologic necrosis of the cryolesions were correlated with the ultrasound images. Based on the results of these experiments, ultrasound-guided cryosurgery of breast cancer was initiated in a human clinical trial.
In phase 1, a single, short-term (< 7 minutes) freeze killed only tumors smaller than 1.5 cm in diameter, despite an apparent decrease to -40 degrees C at the periphery of each tumor. In phase 2, varying the peripheral tumor temperature to as low as -70 degrees C, using a single, short-term (< 7 minutes) freeze did not alter the results from phase 1. If the ice ball fully encompassed the tumor, however, maintaining it for at least 15 minutes achieved 100% tumor kill independent of tumor size. In phase 3, creation of a reproducible ultrasound-monitored cryolesion was facilitated when 2 freeze-thaw cycles were performed. No procedure-related complications were noted. In the human trial, 2 invasive lobular carcinomas from 1 patient were treated by cryosurgery and were negative for persistent tumor by core needle biopsy performed 4 and 12 weeks after a well-tolerated procedure.
In situ breast cryosurgery has been proved to be feasible and efficacious in small and large animal studies and has been successfully performed in 1 patient with breast cancer. The results of this study suggest that ultrasound-guided cryosurgery of breast cancer warrants further investigation.