Ice Versus Surgery for Early Breast Cancer

Today’s topic: Ice versus surgery for early breast cancer.

As an oncologist, I help individuals with cancer.

Imagine my surprise when I recently stumbled across this headline:

“Cryoablation On Par With Excision for Early-Stage Breast Cancer Recurrence.”

On a side note, I remember the film “Realive.”

In this 2016 movie, a throat cancer-stricken artist named Marc chooses cryonic freezing to preserve his life in the hope of being thawed and continuing his life in a future where clinicians might cure the cancer.

It’s not a great film, but it has an interesting concept.

Cryotherapy: Freezing as Cancer Treatment

In real life, doctors sometimes use cryoablation — which freezes cancer cells to kill them — in place of traditional approaches such as surgery.

For example, prostate cancer cryotherapy is a treatment that utilizes freezing temperatures to eliminate cancerous prostate tissue. 

Doctors perform this procedure by inserting thin metal probes into the skin and the prostate gland. 

A gas circulated through these probes causes the targeted prostate tissue to freeze, leading to the death of cancer cells. 

Cryotherapy can be a treatment option for early-stage prostate cancer confined to the prostate, particularly when other treatments are not feasible. 

Clinicians sometimes use it in cases where prostate cancer has recurred following initial therapy.

Cryotherapy for prostate cancer
www.mayoclinic.org

Cryotherapy for Breast Cancer?

Surgery remains the gold standard local treatment for breast cancer.

However, an operation can be challenging for some, including older patients.

Can we identify a subset of patients with early breast cancer who have favorable biological characteristics and could avoid surgical intervention altogether?

A new study suggests the answer may be yes.

How does breast cancer cryoablation work?

Cryoablation is a medical procedure that uses extremely cold temperatures, as low as -170°C, achieved with rapid freezing, to destroy unwanted tissue, like tumors. 

This method ensures complete cell destruction below -19°C.

Here’s a breakdown of how it works:

• Direct Damage: Rapid freezing causes ice crystals to form inside cells. This process disrupts normal function and leads to cell death. It also dehydrates cells, further damaging them.
• Indirect Damage: The freezing process damages blood vessels, leading to a lack of blood flow (ischemia) in the treated area, contributing to tissue destruction.
• Immune Response: Cryoablation can trigger the body’s immune system to fight cancer cells in the treated area and potentially elsewhere in the body (the abscopal effect). How cells die during cryoablation (necrosis vs. apoptosis) influences this immune response. When cells release their contents, they can activate immune cells like cytotoxic T lymphocytes. The T lymphocytes can then target and destroy cancer cells. However, this immune response can have both anti-cancer and potentially cancer-promoting effects.

Cryoablation is a convenient option because it can often be done in a doctor’s office using local anesthesia, which is generally easier for patients to tolerate. 

It can also result in better cosmetic outcomes and may be more cost-effective than other treatments.

Does Breast Cancer Cryoablation Work?

Researchers designed the ICE3 clinical trial to assess how safe and effective cryoablation is for treating women aged 60 and older who have early-stage breast cancer that is considered low-risk. 

The main goal of the study was to see if the cancer came back in the same breast (ipsilateral breast tumor recurrence) within five years after the cryoablation treatment. 

Doctors did the cryotherapy in an office.

The procedure took 20 to 40 minutes, depending on the lesion size.

The patients had clinical and imaging assessments at six months and then annually for up to five years. 

The team evaluated patient and physician satisfaction with cosmetic outcomes.

Study Results – Ice Versus Surgery for Early Breast Cancer

The investigators published the study results in the Annals of Surgical Oncology in 2024.

The average patient age was 75.

The 5-year rate of in-breast recurrence was 4.3 percent.

The five-year breast cancer survival rate in this group was high at 96.7 percent. 

Cryoablation Complications: None.

Importantly, the study did not report any significant adverse events or complications linked to the cryoablation device.

Patient satisfaction with the procedure’s cosmetic results was 100%.

Furthermore, study participants reported decreased distress scores six months after the cryoablation treatment, indicating improved overall well-being.

Final Thoughts – Ice Versus Surgery for Early Breast Cancer

Confirmatory studies could lead to breast cancer cryoablation becoming a reasonable alternative to surgery for highly selected older patients.

Exciting.

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