738 - Candidates, Outcomes, and Emerging Evidence for an IR Focused Breast Cancer Treatment Plan: A Topical Review of Cryoablative Therapy for Breast Neoplasms

Learning Objectives: (1) Understand the effectiveness of cryoablation for breast neoplasms. (2) Determine appropriate candidates for cryoablation. (3) Become familiar with cost effectiveness of cryoablation in proper candidates compared to breast conserving surgery (BCS). (4) Understand the future applications of cryotherapy for breast neoplasms

Background: Breast cancer is the most common neoplasm in women; traditional therapy primarily involves surgical resection and pharmacotherapy. Cryoablative techniques are well tolerated, minimally invasive, cost effective, and timely procedures that may augment traditional therapy{1,4}. Cryoablation is gaining traction as a potential first line or adjunctive therapy for eligible patients. Driving factors in the growing interest include patient tolerance to procedures, patient survival rates, and cosmetic perseverance{1,3,4}.

Clinical Findings/Procedure Details: Patients with unifocal low grade ER/PR+, HER 2- lesions < 1.5 cm, poor surgical candidates, and patients considering good cosmetic outcomes are ideal candidates for cryotherapy{1}. In the ICE3 trial, technical success was 100% and the breast cancer survival rate was 96.7% (n=194) at 5 years{1}. Navarro et al. demonstrated a 100% technical success rate and a 97% eradication rate in pure IDC{2}. For IDC tumors < 1.5 cm, recurrence rates are comparable between BCS at 4.6% and cryotherapy at 4.3% at 5 year follow up{1,5}. Jean et al demonstrated a 10% recurrence rate in patients with an average breast mass of 2.7 cm via cryotherapy{7}. Additionally, the average cost of cryotherapy compared to lumpectomy is $2,221.70 and $16,896.50, respectively{6}.

Conclusion and/or Teaching Points: Cryoablation is a potential alternative therapy for percutaneous management of breast cancer in select patient populations. While the ICE3 trial showed breast cancer recurrence similar to BCS for tumors < 1.5cm, Jean et al showed higher recurrence rates at 10% for tumors averaging 2.7 cm, suggesting that smaller tumors are more appropriate for cryoablation {1,5,7}. In addition, cryoablation has a shorter postoperative recovery, better cosmetic outcome and has a lower average cost compared to lumpectomy, however more studies are needed to validate these findings.