at SciVerse ScienceDirect

The Breast 21 (2012) 601e603

Contents lists available

The Breast

journal homepage: www.elsevier .com/brst

Short report

Radiofrequency thermoablation in locally advanced breast cancer

Giuseppe Santoro a,*, Mario Avossa a, Marcello Della Corte b

aDepartment of General and Oncological Surgery, S.Giovanni di Dio e Ruggi d’Aragona University Hospital, Salerno, ItalybDepartment of General and Emergency Surgery, S.Giovanni di Dio e Ruggi d’Aragona University Hospital, Salerno, Italy

a r t i c l e i n f o

Article history:Received 14 November 2011Received in revised form1 February 2012Accepted 5 February 2012

Keywords:ThermoablationRadiofrequencyBreast cancer

* Corresponding author.E-mail address: santoro@amalfinet.it (G. Santoro).

0960-9776/$ e see front matter � 2012 Published bydoi:10.1016/j.breast.2012.02.005

a b s t r a c t

The authors report their experience of 8 cases of breast cancer in six patients, treated by radiofrequencythermoablation. Two patients had bilateral breast cancer infiltrating the skin. All patients, but one, werealive at two years follow-up. The age range was 54e75 years old (median, 71 years old). We observedcomplete regression in one patient, regression with residual scar in two patients and partial regression inthe remaining three patients.

The authors believe that radiofrequency, alone or associated with other treatments, is an easy anduseful alternative for the management of breast cancer, in selected patient who cannot undergo surgeryor refuse surgical treatment and other treatments.

� 2012 Published by Elsevier Ltd.

Introduction

Thermoablation is an easy and repeatable procedure and it canbe carried out as a day case under local anaesthetics. Furthermore,it can be associated with other treatments like surgery, hormonaltherapy, radiotherapy, and preoperative bulk reduction chemo-therapy. A preliminary feasibility studies carried out by Fornage BDet al,2 has shown the safety and feasibility of US guided radio-frequency thermoablation in small (�2 cm) breast cancer.

We report our experience of radiofrequency thermoablation inlarger breast cancers (median size of 4 cm), of which three hadpalpable axillary nodes.

Material and methods

Over a period of 36 months we treated 8 cases of breast cancerby thermoablation. All patients had local advanced disease. Twopatients had bilateral advanced breast cancer.

All patients had refused to undergo surgical treatment andchemotherapy as perceived as high risk, despite having beeninformed accurately of the risk/benefit of any treatment.

Contributing factors that had lead patients to refuse any form ofsurgical treatment were recent stroke, past history of other types ofcancer (including malignant skin cancer and uterine cancer),depression, severe heart disease. All patients competence wascarefully assessed before considering their decision as binding.

Elsevier Ltd.

Median age was 71 years old (range: 54e75 years old). Mediantumour size was 38.5 mm (range: 25 mm to 60 mm) (Table 1). Inthree cases, axillary nodes were palpable prior to treatment. In fourpatients carcinoembryonic antigen (CEA) and Cancer Antigen 15e3(Ca 15e3) were raised. Mammograms and cytology were positive inall patients (Fig. 1). Hormone receptor status is reported in Table 1.

Prior to the procedure all patients underwent a standard pre-operative workup consisting of Chest X-ray, ECG, routine bloodtests, as requested by the anesthetist, should sedation or emer-gency intubation be required, and oncologic markers, as perinternal protocol.

The procedure was carried out using Valleylab’s Cool-tip� RFElectrode ACT2030 needles that were inserted inside the tumourunder ultrasound guidance. The radiofrequency generator was usedto deliver a temperature of 60� C for 15 min within the tumour.Ultrasonography was used to assess the effectiveness of the treat-ment. During vaporization of the tumour associated to the thermaleffect a hyperecoic area extended gradually to the whole tumour. Inall patients the procedure was successfully carried out under localanaesthesia.

In the weeks that followed the procedure the gradual disap-pearance of peritumoral inflammation was assessed ultrasono-graphically. In one patient who was affected by severe cardiacdisease and orthopnoea, the procedure could be carried out withthe patient sitting in upright position.

One diabetic patient who had a nodule infiltrating the cuta-neous layer suffered a second degree skin burn, which wassuccessfully treated with simple dressings and careful monitoringof blood glucose levels.

Table 1Features of patients with breast cancer treated with TA at our institution.

Patients Age No. of breastcancers

ERc PgR Ki67 Tumour size before T.A. Tumour size after T.A. AssociatedPathologies

Relatedtreatments

1 DS 54 1 þ þ 30% 35 mm 0 mm DepressionHysterectomy for Primarycarcinoma

A.I.

2 NC 69 1 þ þ e 37 mm 10 mm scar Stroke A.I.3 AD 72 1 þ þ e 30 mm/50 mm 15 mm/30 mm Diabetes

Ischaemic Heart DiseaseTAM

4 OG 73 2 bilateral) þ þ e 50 mm/60 mm 30 mm/35 mm Bone Metastasis A.I.5 SM 70 2(bilateral) þ þ 20% 25 mm 12 mm Congestive heart Failure

PericarditisDepressionAortic Aneurysm

TAM

6 MG 75 1 þ þ e 40 mm 10 mm scar Skin CancerSenile dementia

TAM

Fig. 1. Mammogram of patient D.S. prior to TA.

Fig. 2. Mammogram of patient D.S. after TA.

G. Santoro et al. / The Breast 21 (2012) 601e603602

G. Santoro et al. / The Breast 21 (2012) 601e603 603

Hormonal therapy was prescribed to all patients. Tamoxifenwasadministered to three patients whereas the other three patientswere treated with aromatase-inhibitors, due to high thromboem-bolic risk.

Results

At two-years followup, five patientswere alive. One patientwhohad undergone TA, following reduction in size of her tumourdecided at a later stage to undergo surgery and chemotherapy atanother institution and died thereafter. All reported a good qualityof life. In two patients the tumour markers had returned to normalvalues. In one patient therewas a complete regression of the tumour(Fig. 2). In two patients we observed a residual scar of 10mm and inthe remaining three we observed a partial size reduction of thetumour with stabilization of the disease. In no patient there was anobservable rapid progression of the disease. One patient, withbilateral advanced disease, died three years after treatment.

Discussion

The effect of heat on cancer cells has been known since ancienttimes. The ancient greek physician Hippocrates had already indi-cated the benefits of heat to treat tumours.

Thermoablation is a technique that uses radiofrequency wavesto generate heat and cause coagulative necrosis of tissues. It can beassociated with tumorectomy to reduce the risk of local recurrence,and with preoperative chemotherapy to reduce the bulk of thetumour. Its use has been advocated in conservative breast surgery(e.g, lumpectomy).1,5

The use of thermoablation to treat early stage breast cancer hasbeen reported to achieve promising results by severalauthors,2,3,5e8 mainly in pilot studies and phase II studies.

In a review of literature carried out on 17 studies, the authorsconclude that RFA represents a promising therapeutic modality forthe treatment of breast cancer.9

It has been suggested that by releasing citokines, thermoa-blation could stimulate the immune system to attack cancer cells.4

In our limited experience the use of radiofrequency in breastcancer at different stages seems a valid tool in selected patientswhorefuse conventional surgery or other treatments or when surgery iscontraindicated. Thermoablation has several advantages: it is easyto perform, it can be carried out under local anaesthetics as a daycase, it is repeatable, and is more easily accepted by patients.

Conclusion

The use of radiofrequency ablation without surgical excision inlocally advanced breast cancer seems to be a promising tool thatcould be useful in selected cases where surgery is not feasible.

In our small series, we observed a significant size reduction ofthe tumour and stabilization of the disease in all patients withlocally advanced disease who otherwise would have undergonehormonal therapy alone. Although the role of TAM or AI has to betaken into account, we believe that the extent of tumour sizereduction and the length of survival could not be accounted byhormonal therapy alone.

However, larger series are necessary to evaluate the effective-ness, limits and indication of thermoablation in the treatment ofearly and advanced breast cancer.

Ethical approval

The authors declare that ethical approval was not required.

Conflict of interest statement

The authors declare that no conflict of interest exists.

Funding source

The study was carried out using hospital resources only with noexternal funding.

References

1. Burak Jr WE, Agnese DM, Povoski SP, Yanssens TL, Bloom KJ, Wakely PE, et al.Radiofrequency ablation of invasive breast carcinoma followed by delayedsurgical excision. Cancer J 2003; Oct 1;98(7):1369e76.

2. Fornage BD, Sneige N, Ross MI, Mirza AN, Kuezer HM, Edeiken BS, et al. Small(�2 cm) breast cancer treated with US-guided radiofrequency ablation: feasi-bility study. Radiology 2004;231:215e24.

3. Quaranta V, Manenti G, Bolacchi F, Cossu E, Simonetti G. Radiofrequency thermo-ablation of not palpable breast carcinoma. thermoablative therapies - IFC- CNR, Pisa(Italy) October 9, 2006.

4. Ekstrand V, Wiksell H, Schultz I, Sandstedt B, Rotstein S, Eriksson A. Influence ofelectrical and thermal properties on RF ablation of breast cancer: is the tumorpreferentially heated? Biomed Eng Online 2005 Jul 11;4:41.

5. Noguchi M, Earashi M, Fujii H, Yokoyama K, Harada K, Tsuneyama K. Radio-frequency ablation of small breast cancer followed by surgical resection. J SurgOncol 2006 Feb 1;93(2):120e8.

6. Noguchi M. Is radiofrequency ablation treatment for small breast cancer readyfor “prime time”. Breast Cancer Res Treat 2007 Dec;106(3):307e14.

7. Yamamoto N, Fujimoto H, Nakamura R, Arai M, Yoshii A, Kaji S, et al. Pilot studyof radiofrequency ablation therapy without surgical excision for T1 breastcancer: evaluation with MRI and vacuum-assisted core needle biopsy and safetymanagement. Breast Cancer 2011 Jan;18(1):3e9.

8. Medina-Franco H, Soto-Germes S, Ulloa-Gómez JL, Romero-Trejo C, Uribe N,Ramirez-Alvarado CA, et al. Radiofrequency ablation of invasive breast carci-nomas: a phase II trial. Ann Surg Oncol 2008 Jun;15(6):1689e95.

9. Soukup B, Bismohun S, Reefy S, Mokbel K. The evolving role of radiofrequencyablation therapy of breast lesions. Anticancer Res 2010 Sep;30(9):3693e7.