Abstract P2-18-11: A multi-center prospective study of image-guided radiofrequency ablation for small breast carcinomas

Abstract

Abstract Background: As the management of breast carcinoma evolves toward less invasive treatments, the next step is the possibility of removing the primary tumor without surgery. The most promising noninvasive ablation technique is radiofrequency ablation (RFA), which can effectively kill tumor cells with a low complication rate. Our preliminary studies of RFA followed by standard surgical resection have indicated that this technique is effective for surgical ablation of small (≤ 2cm) breast tumors without extensive intraductal components (EIC). Methods: To determine if RFA is oncologically and cosmetically appropriate for the local treatment of primary breast carcinoma, this multi-center prospective study used RFA as the sole local treatment of breast tumors ≤ 1.5cm in size on ultrasound and MRI. Exclusion criteria include receiving of preoperative chemotherapy, or the presence of invasive lobular carcinoma or invasive ductal carcinoma with suspicious EIC. After confirmation that the standard baseline core biopsy for diagnosis and measurement of tumors markers (ER, PgR, HER-2/neu expression and the presence of the Ki-67 proliferative marker) have been obtained, consent will be obtained and the patient scheduled RFA. All patients received adjuvant radiation therapy. The use and choice of systemic therapy will be based on the information from the baseline core biopsy and imaging studies. The first primary endpoints of this study is successful tumor ablation, as evidenced by negative findings on vacuum-assisted or core biopsies and imaging studies after RFA. The second primary endpoints is the incidence of procedure related adverse events. Forty patients with small tumors that are clearly identifiable and measurable by ultrasound and MRI were enrolled. The response to ablation was evaluated with both vacuum-assisted or core biopsies and imaging studies every 3 months during the first year. The long-term outcomes were assessed using quality of life measurement scales and imaging studies every 6 months thereafter through year 5. Results: Of the 58 patients who participated in this study, 55 completed the protocol. In 50 of the 55 (91%) treated patients, successful tumor ablation, as determined by negative findings on vacuum-assisted or core biopsies and imaging studies, was confirmed. In these 50patients, there were no local or distant recurrences after 1 year. The remaining 5 patients with biopsies positive for residual tumor underwent surgical resection. In 46 of the 50 patients with successful ablation, cosmetic outcomes were excellent after 1 year and only 2 patients experienced minor skin burns during the tumor ablation. No other adverse events were reported. Conclusions: RFA can be safely used alone in patients with small breast tumors, provided that local tumor control must be regularly assessed by image-guided vacuum-assisted or core biopsies after ablation. RFA in patients with early breast carcinoma can achieve local control rates similar to those with wide local excision, but with improved cosmetic results. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-18-11.