Breast cancer: Access to cryoablation expands at CHUM

Cryoablation, offered as a Quebec first at the University of Montreal Hospital Centre since last year, is now accessible to a greater number of breast cancer patients, the Canadian Press has learned.

Initially reserved for patients whose tumours measured no more than 1.5 centimeters, this innovative cold ablation technique is now sometimes used to reduce the size of larger tumours and prevent complications.

If nothing is done, reminded Dr. Matthew Seidler, head of the breast imaging section in the CHUM radiology department, the tumour will continue to grow, to the point where it can cause pain and even eventually break the skin and become infected.

“It’s really problematic to manage, especially for an elderly patient who is at the end of their life,” he explained. So in certain contexts, we can now offer palliative cryoablation to reduce the size of the tumour so that it causes fewer symptoms.”

Cryoablation literally consists of “freezing” the cancerous tumour using an ultrafine needle. The procedure, which is performed under local anesthesia, leaves virtually no scarring, and the patient is usually discharged the same day.

Rapid freezing at -40°C and subsequent thawing cycles trigger a kind of cell death cascade that destroys the tumour. Not only does the cold cause the death of cancer cells, but it also triggers the expression of tumour antigens that are then recognized by the human body, triggering an inflammatory response from the immune system.

In the context of breast cancer, Dr. Seidler reminded us, “what kills patients isn’t necessarily the tumour in the breast, it’s when the patient develops metastases” and the disease spreads elsewhere.

When the tumour is small, he added, we can be reasonably certain that it will be completely frozen. But with a larger tumour, “it’s more difficult to be sure that the tumour is completely encased in our ice cube and (…) we run the risk of having residual disease.”

“In a situation like this, the goal is rather to reduce the tumour burden to avoid complications,” explained Dr. Seidler.

By 2025, he added, breast cancer treatment involves an “arsenal” of therapies—surgery, radiotherapy, immunotherapy, chemotherapy, etc. – and we know that it’s this “multidisciplinary approach” that will achieve the “best results.”

“Treatments have a synergistic effect,” said Dr. Seidler. “So it’s always better to combine treatments when possible.”

The recently released results of the ICE3 clinical trial also support this view.

These data reveal that 3.6 per cent of the 194 patients treated with cryoablation had experienced a relapse after five years, “which is still very good,” said Dr. Seidler.

The relapse rate was only 2.6 per cent among patients who received adjuvant treatment in addition to cryoablation.

“It’s statistics like these that encourage me to explain to my patients that yes, cryoablation can be a good option, but ideally, it should be combined with other treatments if possible,” said Dr. Seidler.

That being said, cryoablation remains a new technique, and the scientific literature on it is sparse compared to that available for other treatments.

We must therefore continue to raise awareness in the medical community; treat more patients to gain more experience; and generate data that will reveal whether the technique can be extended “to other indications,” explained Dr. Seidler.

“I hope that in a year we will be able to offer this treatment to even more patients,” he said.

–This report by La Presse Canadienne was translated by CityNews