Radiofrequency Ablation Of Breast Cancer Research Articles

Magnetic resonance imaging-guided radiofrequency ablation of breast cancer: a current state of the art review.

With a gradual increase in breast cancer incidence and mortality rates and an urgent need to improve patient prognosis and cosmetology, magnetic resonance imaging (MRI)-guided radiofrequency ablation (RFA) therapy has attracted wide attention as a new treatment method for breast cancer. MRI-RFA results in a higher complete ablation rate and extremely low recurrence and complication rates. Thus, it may be used as an independent treatment for breast cancer or adjuvant to breast-conserving surgery to reduce the extent of breast resection. Furthermore, with MRI guidance, accurate control of RFA can be achieved, and breast cancer treatment can enter a new stage of minimally invasive, safe, and comprehensive therapy. With progress in MR thermometry technology, the applications of MRI are expected to broaden.

Formosanin C promotes the curative efficacy of ultrasound-guided radiofrequency ablation in a mouse model of breast cancer.

Breast cancer is the leading cause of tumor-associated death among women worldwide, and new therapeutic strategies are required to improve the post-surgery prognosis and quality of life of patients. Radiofrequency ablation (RFA) is a less invasive approach compared with traditional surgical resection to treat malignancies, and the combination of RFA and chemotherapeutic agents, including formosanin C (FC), can synergistically improve the curative effects against breast carcinoma. However, the detailed mechanisms remain unclear. In the present study, nude mice were used to identify the influence of FC on the therapeutic efficacy of RFA for breast cancer. Flow cytometry was performed to demonstrate the proportional alteration of CD8+ and CD45+ T cells with different biomarkers, including CD107a, IFNγ and TNFα. It was demonstrated that FC enhanced the therapeutic efficacy of RFA in breast cancer, while RFA combined with FC improved the proportion of IFNγ+ and TNFα+ CD8+ T cells and CD107a+ CD8+ T cells in tumor-infiltrating lymphocytes, thus increasing the immune responses caused by surgery and chemotherapy. The present study indicated that FC may promote the curative efficacy of ultrasound-guided RFA against breast tumor by regulating adaptive immune responses.

MRI features after radiofrequency ablation in breast cancer.

MRI features after radiofrequency ablation in breast cancer.

Clinical assessment of magnetic resonance imaging-guided radiofrequency ablation for breast cancer.

The aim of the present study was to investigate the efficacy of magnetic resonance imaging (MRI)-guided radiofrequency ablation (RFA) for breast cancer patients who cannot undergo traditional surgery. A total of 10 patients were treated by MRI-guided RFA, of whom 6 had stage IV disease (lung metastasis n=3, bone metastasis n=1, liver metastasis n=1 and mediastinal metastasis n=1) and the remaining 4 patients, who refused surgery, had stage III disease accompanied by severe underlying conditions. The changes in feasibility, tumor volume, bleeding, local recurrence, metastasis and complications were evaluated after RFA. The patients were followed up at 1, 3, 6 and 12 months, and annually thereafter. A total of 14 RFA sessions were successfully performed (100%) in the 10 patients, among whom 7 patients underwent a single RFA session, 2 patients underwent two sessions, and 1 patient underwent three sessions. Compared with pre-RFA, the volume of the tumors at 6 months after RFA was markedly decreased. There was no local tumor recurrence or metastasis detected during a mean follow-up period of 19.5±3.46 months, and no major complications were reported. Therefore, RFA was found to be a minimally invasive and feasible treatment method in the present study, and MRI-guided RFA may be a promising alternative option for breast cancer patients who are unable to tolerate surgery. However, more prospective studies on the applicability of RFA in breast cancer are required.

287 (PB-082) - Radiofrequency ablation of breast cancer followed by surgical excision versus standard surgery. Results from an unicenter open-label phase II study

287 (PB-082) - Radiofrequency ablation of breast cancer followed by surgical excision versus standard surgery. Results from an unicenter open-label phase II study

Radiofrequency Ablation of Breast Cancer: A Retrospective Study

PurposeTo validate the safety and efficacy of percutaneous radiofrequency ablation (RFA) of breast carcinomas. MethodsThis retrospective study was conducted by the Breast Cancer Society for Minimally Invasive Therapy following approval from institutional review boards, and with the written informed consent of patients. A total of 386 patients with breast cancer treated with RFA at 10 institutions between July 2003 and June 2009 were identified and included in the analysis. Patients underwent a standard RFA procedure with ultrasound guidance and were followed up every 6 to 12 months. In this study, feasibility of RFA procedure and related safety and ipsilateral breast tumor recurrence (IBTR) were examined. Fisher exact or χ2 test evaluated associations between clinicopathological factors and IBTR, and local recurrence-free survival was estimated using the Kaplan-Meier method. ResultsRFA-related adverse events included local pain in 9 patients, skin burns in 15, and nipple retraction in 7. Patients were followed for a median of 50 months. IBTR was more frequently observed in patients with initial tumor sizes > 2 cm (3 of 30, 10%) than in those with initial tumors ≤ 2 cm (8 of 355, 2.3%; P = .015). IBTR-free rates 5 years after RFA were 97%, 94%, and 87% in patients with initial tumor sizes ≤ 1.0 cm, 1.1 to 2.0 cm, and > 2.0 cm, respectively. ConclusionsRFA in breast cancer is a safe and promising minimally invasive treatment for tumors ≤ 2 cm in diameter. Further studies are needed to optimize the technique and evaluate its future role as local therapy.

A meta-analysis of clinical trials assessing the effect of radiofrequency ablation for breast cancer.

BackgroundRadiofrequency ablation (RFA) is a minimally invasive thermal ablation technique. We conducted a meta-analysis based on eligible studies to assess the efficacy and safety of RFA for treating patients with breast cancer.MethodsA literature search was conducted in PubMed, Embase, and Web of Science databases. Eligible studies were clinical trials that assessed RFA in patients with breast cancer. The outcomes included complete ablation rate, recurrence rate, excellent or good cosmetic rates, and complication rate. A random-effects or fixed-effects model was used to pool the estimate, according to the heterogeneity among the included studies.ResultsFifteen studies, with a total of 404 patients, were included in this meta-analysis. Pooled results showed that 89% (95% confidence interval: 85%–93%) of patients achieved a complete ablation after RFA treatment and 96% of patients reported a good-to-excellent cosmetic result. Although the pooled result for recurrence rate was 0, several cases of relapse were observed at different follow-up times. No RFA-related complications were recorded, except for skin burn with an incidence of 4% (95% confidence interval: 1%–6%).ConclusionThis meta-analysis showed that RFA can be a promising alternative option for treating breast cancer since it produces a higher complete ablation rate with a low complication rate. Further well-designed randomized controlled trials are needed to confirm the efficacy and safety of RFA for breast cancer.

Radiofrequency ablation and breast cancer: a review.

Radiofrequency ablation (RFA) use in breast cancer is a developing area of research. There have been a number of published studies over the last decade, which explores the feasibility of minimally invasive techniques in breast cancer treatment. In this review, we will discuss the most recent data on radiofrequency ablation and examine the current methods, outcomes, complications, and limitations of RFA in breast cancer therapy. Pub Med search for English Language articles on RFA in breast cancer. More than 25 studies were reviewed and we searched for number of tumors, average size, electrode used, if they successfully ablated the tumor, when the tumor was then resected and if the patients experienced any complication from the ablation. Radiofrequency ablation is an emerging minimally invasive therapy in small, localized breast cancer. Currently, no clinical trials have been published to directly compare RFA to the current standard of surgical resection. Ultimately, RFA will need clinical trials to evaluate oncologic outcomes involving long interval follow-up to determine survival, local control and disease progression before it becomes a reasonable alternative to surgical resection.

Corrections: 2009 San Antonio Breast Cancer Symposium Abstracts

Corrections: 2009 San Antonio Breast Cancer Symposium Abstracts

RFA for Small Breast Cancer — What Tumor Can Be Treated Safely?

Abstract Breast conserving surgery for small breast cancer has been acceptable as one of standard treatments. However, there are some patients who do not be satisfied with the cosmesis. The aim of this study is to verify the clinical safety and usefulness of the RadioFrequency Ablation (RFA) for small breast cancer without resection. Between January 2006 and Octobar 2007, 20 breast cancer patients were performed RFA with cool-tip RF system after sentinel LN biopsy under general anesthesia. All patients has consented as a clinical research, beforehand. MR mammography was performed after 3 and 6 months of follow-up. All patients were performed postoperative histological examination by 8G-needle mammotome biopsy after 6 months MRI evaluation.Tumor viability after RFA was assessed by hematoxylin -eosin and ssDNA staining. QOL after RFA was assessed both subjectively(QOL-ACD score) and objectively(JBCS cosmesis criterion). Preoperative mammotome revealed 4 patients had DCIS and 16 patients had IDC. The patients median age was 53 years old. The mean greatest dimension of tumors was 1.0 cm (range, 0.5-1.5 cm). MRI showed the dimention of coagulation necrotic area by RFA treatment was 3.5cm (range, 2.5-5.4 cm).All patients have been performed postoperative histlogical examination by 8G mammtome biopsy 6 month after RFA treatment. Coagulation necrosis of the tumor was complete in 20of 20 patients (100%).No patient was troubled skin burn. Neither local and distant recurrence has occurred in all patients (median follow up was 30 month). To treat RFA for breast cancer more safely, we analyzed factors which influenced the size of necrosis. Patient age, body mass index (BMI), background concentration measured by MMG, Fat involvement measured by CT did not influence with the size of nectosis (P=0.21,0.17,0.64,0.40). The state of posterior echo detected by ultrasonography was associated with the size of necrosis (p=0.045). Hence, RFA for the tumor with rich fiber such as scirrhous type tend to make necrosis wider than one with poor fiber such as solid tubular type.Most of patients were satisfied with the cosmesis of the RFA treated breast. Objective QOL score (JBCS cosmesis criterion) showed splendid cosmetic outcome. RFA is one of the effective local treatment for small breast cancer (< 1.5 cm in diameter), and bring breast cancer patients cosmetic satisfaction. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4119.

Radiofrequency Ablation in Breast Cancer.

Abstract Background: Radiofrequency ablation (RFA) of breast tumors is characterized by variable efficiency. Cell viability is principally evaluated by NADH-diaphorase and Hematoxylin-eosin (H&E) staining techniques.Methods: Twenty patients with breast cancer, 20.7 ± 9.14mm in diameter, underwent RFA of the tumor and of the margin of surrounding breast tissue. RFA was based on the radiofrequency impedance-switching algorithm. The algorithm was based on an internally cooled probe, which carried out algorithm-guided deposition of heat in a pulse-cycle fashion and under continuous monitoring of the desiccation status of the ablated site to avoid tissue charring (until its impedance level reached 30Ω above the baseline level or a maximum time interval (tmax) was reached). A minimum time interval of 5 seconds was set as the duration of time that the electrode must be off. If the cycles of power application occurred too rapidly, the power was diverted to the 150Ω resistance load for the remainder of the 5-second interval. Surgical resection was the next step. Sixteen patients underwent quardzantectomy (five with axillary lymph node dissection) and four unilateral total mastectomy. In fifteen patients SLNB was searched and identified (ten negative, four positive and one failure). The ablated tumor tissue was histologically examined and Ki67 immunohistological staining was applied to evaluate cellular proliferation, invasion and survival.Results: The mean time of operation was 119.47 ± 23.35minutes.The mean time of RFA was 12 - 15minutes. One patient had a post-operative complication (trauma infection). All twenty patients had a positive Ki67 immunohistochemical staining mean value of 28.79 ± 21.42, before RFA. The post-RFA Ki67 expression was zero in sixteen patients. In three patients no residual tumor cells were found and in one patient the Ki67 expression was under five percent. Recurrence developed in zero patients, to date (follow up time: 22.5 ± 2.3 months).Conclusion: Ki67 evaluation is a targeting indicator of viability of malignant cells after lesion RFA of breast tumors. RFA is able to provide satisfactory local control in breast cancer. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2106.

Radiofrequency ablation of breast cancer: a comparative study of two needle designs

Radiofrequency ablation (RFA) is an emerging minimally invasive technique for breast cancer treatment. There are two different needle designs. One is to deploy a series of arrays to allow an even distribution of heat within the tumor. A new design is a straight needle with continuous infusion of cold saline to prevent charring and ensure continuous heat delivery. We report the first comparative study using two different needles for ablation of breast cancer. Chinese patients with breast cancer less than 2cm were prospectively recruited. Multifocal tumor was excluded. RFA was performed under general anesthesia following sentinel node biopsy. Sequential allocation was used. In the first group, tumor was ablated by using the LeVeen needle. Cool-tip needle was used in the subsequent group. The tumor was then resected. Tumor viability was assessed by nicotinamide adenine dinucleotide-diaphorase (NADH) staining. Complete ablation rate was compared. Evidence of thermal damage to the skin was also assessed. Twenty patients were recruited. Mean tumor size was 14mm. Complete ablation rate was the same (90% versus 89% for the Cool-tip and the LeVeen, respectively). Cool-tip has a shorter ablation time when compared with LeVeen (12 versus 28min), and the Cool-tip needle was found to be easier to insert. There was no visible skin burn after RFA. Cool-tip and LeVeen systems had the same efficacy in ablation of breast cancer, but Cool-tip was easier to insert and had a shorter ablation time.

Ultrasound-Guided Bipolar Radiofrequency Ablation of Breast Cancer in Inoperable Patients: a Pilot Study

Radiofrequency ablation (RFA) is a promising minimal invasive modality to treat small breast cancer (BCA). In most studies cancers were surgically excised shortly after RFA. We present six patients inoperable when diagnosed with BCA, and performed RFA instead of surgery. Ultrasound-guided bipolar RFA was performed under local anesthesia in six women aged 63 - 85 years. They had core-biopsy proven T 1 - 2N0 M0, grade I or II, 1.0 - 2.7 cm sized invasive ductal cancers, with positive estrogen receptor status. Four tumors measured > 2 cm, and three 1.0 - 1.2 cm in diameter. Patients were at high-risk for general anesthesia and surgery because of severely impaired cardiac function, advanced age, or associated diseases (acute myeloid leukaemia (AML), diabetes, hypertension, depression) and/or refused surgery. Six tumors in five patients were completely ablated, without recurrence during follow-up (range: 9 - 49 months). One superficially located cancer was partially ablated; the patient died two months later from myocardial infarction. The Patient with AML and BCA had an infection of the treated breast after 4 months and postponed mastectomy to an AML remission status. There were no signs of malignancy in histopathology; the patient finally died of leukemia 42 months after RFA. The remaining four patients are well, without complications. Ultrasound-guided percutaneous RFA under local anesthesia is an effective alternative to surgery for BCA < 3 cm in patients with a high-risk for surgery.

Radiofrequency Ablation Therapy for Small Breast Cancer

There is increasing demand for minimally invasive and nonsurgical treatment methods for patients with small breast cancer, and radiofrequency (RF) ablation seems the most promising nonsurgical ablation technique for the treatment of breast cancer. However, a number of problems remain to be resolved in the practical use of RF ablation. This review article discusses the relevance and applicability of RF ablation for small breast cancer. A review of the English language medical literature was performed using Medline database software cross-referencing major articles on the subject. Several feasibility studies indicated that RF ablation can effectively eradicate breast cancer cells, and early results of pilot studies have shown that this technique is promising for the local treatment of small breast cancer. However, a major problem of RF ablation is the inability to assess the margins of the treated lesion. RF ablation for breast cancer should still be considered in the investigative stage. We propose a new method of RF ablation followed by percutaneous excision of the ablated tumor. A combination of RF ablation and percutaneous en bloc excision using an Ovation breast biopsy device may provide clear margins and full histological workup with better cosmetic results. Further studies are needed to determine whether the use of RF ablation and breast irradiation for local treatment of primary breast cancer may result in local recurrence and can produce survival rates equivalent to those obtainable with conventional BCT.

MRI‐guided radiofrequency ablation of breast cancer: Preliminary clinical experience

This study was designed to demonstrate the feasibility of MRI-guided radiofrequency ablation (RFA) of breast cancer. A total of three women diagnosed with invasive ductal breast cancer were treated with percutaneous MRI-guided RFA, according to a treat and resect protocol, in our hospital. RFA procedures were performed in an open 0.5T Signa-SP imager allowing direct patient access and real-time monitoring of the procedure. In all patients ablation was performed with a 15-gauge insulated MRI-compatible multiple needle probe. MRI thermometry and contrast-enhanced postablation MRI were used to evaluate the ablation process. Patients underwent lumpectomy within a week of the RFA procedure. Histopathology confirmed successful (100%) tumor ablation in one patient, and partial tumor destruction (33% and 50%, respectively) in two patients. Challenges of MRI-guided breast RFA that need to be solved to facilitate progress of the technique toward clinical practice are discussed.

Influence of electrical and thermal properties on RF ablation of breast cancer: is the tumour preferentially heated?

BackgroundTechniques based on radio frequency (RF) energy have many applications in medicine, in particular tumour ablation. Today, mammography screening detects many breast cancers at an early stage, facilitating treatment by minimally invasive techniques such as radio frequency ablation (RFA). The breast cancer is mostly surrounded by fat, which during RFA-treatment could result in preferential heating of the tumour due to the substantial differences in electrical parameters. The object of this study was to investigate if this preferential heating existed during experimental in vitro protocols and during computer simulations.MethodsExcised breast material from four patients with morphologically diagnosed breast cancers were treated with our newly developed RFA equipment. Subsequently, two finite element method (FEM) models were developed; one with only fat and one with fat and an incorporated breast cancer of varying size. The FEM models were solved using temperature dependent electrical conductivity versus constant conductivity, and transient versus steady-state analyses.ResultsOur experimental study performed on excised breast tissue showed a preferential heating of the tumour, even if associated with long tumour strands. The fat between these tumour strands was surprisingly unaffected. Furthermore, the computer simulations demonstrated that the difference in electrical and thermal parameters between fat and tumour tissue can cause preferential heating of the tumour. The specific absorption rate (SAR) distribution changed significantly when a tumour was present in fatty tissue. The degree of preferential heating depended on tissue properties, tumour shape, and placement relative to the electrode. Temperature dependent electrical conductivity increased the thermal lesion volume, but did not change the preferential heating. Transient solutions decreased the thermal lesion volume but increased the preferential heating of the tumour.ConclusionBoth the computer model and the in vitro study confirmed that preferential heating of the tumour during RFA exists in breast tissue. However, the observed preferential heating in the in vitro studies were more pronounced, indicating that additional effects other than the difference in tissue parameters might be involved. The existing septa layers between the cancer tissue and the fatty tissue could have an additional electrical or thermal insulating effect, explaining the discrepancy between the in vitro study and the computer model.

Radiofrequency Ablation of Breast Cancer

Radiofrequency ablation (RFA) is currently under study as a candidate for nonsurgical removal or destruction of breast tumors. RFA of solid tumors is produced by frictional heating caused when ions in the tissue attempt to follow the changing directions of a high-frequency alternating current. The radiofrequency probe is typically placed into the tumor under ultrasound guidance, and the ablation is performed with real-time ultrasound monitoring. Preliminary studies in which RFA was followed by standard surgical resection have indicated that this technique is effective for the surgical ablation of small (< or = 2 cm) primary breast tumors. A new study at the University of Texas M.D. Anderson Cancer Center will use RFA as the sole local treatment of breast tumors < or = 1.5 cm in size to determine whether this technique is oncologically and cosmetically appropriate for the local treatment of primary breast cancer. Twenty patients with small tumors that are clearly identifiable and measurable by ultrasound will be enrolled in the study. Local control will be assessed by core and fine-needle biopsies, and long-term outcomes will be assessed using imaging studies and quality-of-life measurement scales for 5 years after treatment.

Radiofrequency ablation of breast cancer: First report of an emerging technology: Jeffrey SS, Birdwell RL, Ikeda DM, et al. Arch Surg 134:1064,1999

Radiofrequency ablation of breast cancer: First report of an emerging technology: Jeffrey SS, Birdwell RL, Ikeda DM, et al. Arch Surg 134:1064,1999