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Ultraschall Med 2010; 31(2): 156-162
DOI: 10.1055/s-0028-1109898
Originalartikel/Original Article

© Georg Thieme Verlag KG Stuttgart · New York

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

Pilotstudie zur ultraschallgestützten bipolaren Radiofrequenzablation von Mammakarzinomen bei inoperablen PatientenB. Brkljacic1 , I. Cikara1 , G. Ivanac1 , A. Hrkac Pustahija1 , R. Zic2 , Z. Stanec2
  • 1Radiology, University Hospital Dubrava
  • 2Plastic surgery, University Hospital Dubrava
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Publication History

received: 7.7.2009

accepted: 14.10.2009

Publication Date:
25 November 2009 (online)

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Zusammenfassung

Ziel: Die Radiofrequenzablation (RFA) ist eine vielversprechende minimalinvasive Behandlungsmodalität für kleine Mammakarzinome (MCA). In den meisten Studien erfolgt die chirurgische Karzinomexzision kurzfristig im Anschluss an die RFA. In dieser Arbeit stellen wir die Fälle 6 inoperabler Brustkrebspatientinnen vor, bei denen eine RFA anstatt der chirurgischen Therapie durchgeführt wurde. Material und Methoden: Bei 6 Frauen (63 – 85 Jahre) wurde eine ultraschallgestützte RFA in Lokalanästhesie durchgeführt. Bei allen lag ein stanzbioptisch gesichertes duktal-invasives Karzinom im Stadium T 1 – 2N0 M0, Grad I oder II mit einer Ausdehnung von 1,0 – 2,7 cm und positivem Östrogen-Rezeptor-Status vor. Vier Tumoren waren > 2 cm, 3 1,0 – 1,2 cm groß. Die Patientinnen hatten ein hohes Risiko für eine Allgemeinnarkose/Chirurgie aufgrund schwerer Herzinsuffizienz, fortgeschrittenem Alter oder konkomitanten Erkrankungen (akute myeloische Leukämie [AML], Diabetes mellitus, Hypertension, Depression) und/oder lehnten einen chirurgischen Eingriff ab. Ergebnisse: Sechs Tumoren bei 5 Patientinnen konnten vollständig abladiert werden und zeigten während des Follow-ups (Range: 9 – 49 Monate) keine Rezidive. Ein oberflächlich lokalisierter Tumor wurde nur partiell abladiert; die Patientin starb 2 Monate später an einem Myokardinfarkt. Die Patientin mit AML und MCA hatte eine Infektion in der behandelten Brust, die Mastektomie wurde in eine Remissionsphase der AML verlegt. Hier zeigte die Histopathologie keine malignen Zellen; die Patientin starb schließlich and der Leukämie 42 Monate nach der RFA. Die weiteren 4 Patientinnen hatten keine Komplikationen und sind wohlauf. Schlussfolgerung: Die ultraschallgestützte Radiofrequenzablation in Lokalanästhesie ist eine effektive Alternative zur chirurgischen Therapie für MCA < 3 cm bei Patientinnen mit einem hohen Operationsrisiko.

Abstract

Purpose: 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. Materials and Methods: 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. Results: 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. Conclusion: 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.

Key words

breast - ultrasound - radiofrequency (RF) ablation

References

  • 1 American Cancer Society .Global cancer facts and figures 2007. Atlanta, Georgia; American Cancer Society, Inc 2007
    Google Scholar
  • 2 Marcy P Y, Magné N, Castadot P. et al . Ultrasound-guided percutaneous radiofrequency ablation in elderly breast cancer patients: preliminary institutional experience.  Br J Radiol. 2007;  80 267-273
    Google Scholar
  • 3 Fischer B, Anderson S, Bryant J. et al . Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy plus irradiation for the treatment of invasive ductal cancer.  N Engl J Med. 2002;  347 1233-1241
    Google Scholar
  • 4 Balducci L, Extermann M, Carreca I. Management of breast cancer in the older woman.  Cancer Control. 2001;  5 431-441
    Google Scholar
  • 5 Daidone M G, Coradini D, Martelli G. et al . Primary breast cancer in elderly women: biological profile and relation with clinical outcome.  Crit Rev Oncol Hematol. 2003;  45 313-325
    Google Scholar
  • 6 Kaufman C S, Rewcastle J C. Cryosurgery for breast cancer.  Technol Cancer Res Treat. 2004;  3 165-175
    Google Scholar
  • 7 Pfleiderer S O, Reichenbach J R, Wurdinger S. et al . Interventional MR-mammography: manipulator-assisted large core biopsy and interstitial laser therapy of tumour of the female breast.  Z Med Phys. 2003;  13 198-202
    Google Scholar
  • 8 Gianfelice D, Khiat A, Amara M. et al . MR imaging-guided focused ultrasound surgery of breast cancer: correlation of dynamic contrast-enhanced MRI with histopathologic findings.  Breast Cancer Res Treat. 2003;  82 93-101
    Google Scholar
  • 9 Huston T L, Simmons R M. Ablative therapies for the treatment of malignant diseases of the breast.  Am J Surg. 2005;  189 694-701
    Google Scholar
  • 10 Jeffrey S S, Birdwell R L, Ikded D M. Radiofrequency ablation of breast cancer: first report of an emerging technology.  Arch Surg. 1999;  134 1064-1068
    Google Scholar
  • 11 Van der Ploeg I MC, Esser van S, Bosch M AAJ. et al . Radiofrequency ablation for breast cancer: a review of the literature.  Eur J Surg Oncol. 2007;  33 673-677
    Google Scholar
  • 12 Curley S A. Radiofrequency ablation of malignant liver tumors.  Ann Surg Oncol. 2003;  10 338-347
    Google Scholar
  • 13 Livraghi van den T, Solbiati L, Meloni F. et al . Treatment of focal liver tumors with percutaneous radiofrequency ablation: complications encountered in a multicenter study.  Radiology. 2003;  226 441-451
    Google Scholar
  • 14 Ueno S, Sakoda M, Kubo F. et al . Kagoshima Liver Cancer Study Group. Surgical resection versus radiofrequency ablation for small hepatocellular carcinomas within the Milan criteria.  J Hepatobilliary Pancreat Surg. 2009;  16 359-366
    Google Scholar
  • 15 Kunkle D A, Uzzo R G. Cryoablation or radiofrequency ablation of the small renal mass: a meta-analysis.  Cancer. 2008;  113 2623-2626
    Google Scholar
  • 16 Gomez F M, Palussiere J, Santos E. et al . Radiofrequency thermocoagulation of lung tumors. Where we are, where we are headed.  Clin Transl Oncol. 2009;  11 28-34
    Google Scholar
  • 17 Burak W E, Agnese D M, Povoski S P. et al . Radiofrequency ablation of invasive breast carcinoma followed by delayed surgical excision.  Cancer. 2003;  98 1369-1376
    Google Scholar
  • 18 Fornage B D, Sneige N, Ross M I. et al . Small (2-cm) breast cancer treated with US-guided radiofrequency ablation: feasibility study.  Radiology. 2004;  231 215-224
    Google Scholar
  • 19 Hayashi A H, Silver S F, Westhuizen N G. et al . Treatment of invasive breast carcinoma with ultrasound-guided radiofrequency ablation.  Am J Surg. 2003;  185 429-434
    Google Scholar
  • 20 Izzo van der F, Thomas F, Delrio P. et al . Radiofrequency ablation in patients with primary breast carcinoma: a pilot study in 26 patients.  Cancer. 2001;  92 2036-44
    Google Scholar
  • 21 Noguchi M, Earashi M, Fujii H. et al . Radiofrequency ablation of small breast cancer followed by surgical resection.  J Surg Oncol. 2006;  93 120-128
    Google Scholar
  • 22 Imoto S, Wada N, Sakemura N. et al . Feasibility study on radiofrequency ablation followed by partial mastectomy for stage I breast cancer patients.  Breast. 2009;  18 130-134
    Google Scholar
  • 23 Khatri V P, McGahan J P, Ramsamooj R. et al . A phase II trial of image-guided radiofrequency ablation of small invasive breast carcinoma: use of saline-cooled tip electrode.  Ann Surg Oncol. 2007;  14 1644-1652
    Google Scholar
  • 24 Medina-Franco H, Soto-Germes S, Ulloa-Gomez J L. et al . Radiofrequency ablation of invasive breast carcinoma: a phase II trial.  Ann Surg Oncol. 2008;  15 1689-1695
    Google Scholar
  • 25 Kontos M, Felekouras E, Fentiman I S. Radiofrequency ablation in the treatment of primary breast cancer: no surgical redundancies yet.  Int J Clin Pract. 2008;  62 816-820
    Google Scholar
  • 26 Earashi M, Noguchi M, Motoyoshi A. et al . Radiofrequency ablation therapy for small breast cancer followed by immediate surgical resection or delayed mammotome excision.  Breast Cancer. 2007;  14 39-47
    Google Scholar
  • 27 Oura S, Tamaki T, Hirai I. et al . Radiofrequency ablation therapy in patients with breast cancers two centimeters or less in size.  Breast Cancer. 2007;  14 48-54
    Google Scholar
  • 28 Wolters U, Wolf T, Stützer H. et al . ASA classification and perioperative variables as predictors of postoperative outcome.  Br J Anaesth. 1996;  77 217-222
    Google Scholar
  • 29 Susini T, Nori J, Olivieri S. et al . Radiofrequency ablation for minimally invasive treatment of breast carcinoma. A pilot study in elderly inoperable patients.  Gynecol Oncol. 2007;  104 304-310
    Google Scholar
  • 30 Eisele R M, Neuhaus P, Schumacher G. Radiofrequency ablation of liver tumors using a novel bipolar device.  J Laparoendosc Adv Surg Tech A. 2008;  18 857-863
    Google Scholar

Prof. Boris Brkljacic

Radiology, University Hospital Dubrava

Avenija G. Suska 6

10000 Zagreb

Croatia

Phone: ++ 3 85/1/2 90 32 55

Fax: ++ 3 85/1/2 90 32 55

Email: boris.brkljacic@zg.t-com.hr