Breast cancer patients at Cedars-Sinai hospital in Los Angeles have a promising cryogenic option to significant intrusive surgeries thanks to cryoablation. Dr. Peter Julien, chief of thoracic imaging and tumor ablation at the S. Mark Taper Foundation Imaging Center at Cedars-Sinai, has been conducting a study using cryoablation to treat low risk breast cancers, avoiding traditional surgical, radiation and chemotherapy treatment.

Julien’s research builds on his past success. He had conducted an earlier study in which he performed cryoablation treatment on 300 patients suffering from kidney cancer. Of those 300, only five returned for a second round of treatment—a 98% success rate—demonstrating complete destruction of tumors after one application. Of the five patients who required a second round of cryoablation, none required a third treatment.

Over the past year and a half, Julien has turned his attention to low risk breast cancer patients through his FROST clinical trials, begun at the University of Michigan. Focusing on single tumors that are less than 15 millimeters in size, he has begun a study that will treat 25 patients. “The most common form that we treat is infiltrating ductile breast cancer,” said Julien in an interview with Cold Facts. “These are usually single tumors that fit our sub-15 millimeter requirement.”

The process begins with an MR. “MR imaging has really changed the way we fight cancer,” he says. “We’re now able to clearly identify all cancerous cells in a patient without having to worry that we may have left some behind—something that has limited use of these techniques in the past. MR clearly details the borders of a tumor. It has opened up a new opportunity where we can treat patients with novel techniques and make sure we’ve gotten all the abnormal cells out without having to perform invasive surgery.”

Once a tumor has been deemed a good candidate for cryoablation, Julien is able to perform the minimally invasive cryoblation procedure. A thin cryoprobe is inserted into the patient through a small incision and guided to the tumor via a wand-like device. Once properly positioned, cryogenic liquid, usually nitrogen or argon, is circulated through the wand to instantly ablate the cancerous cells. The process works by breaking down intercellular proteins within the cell membranes into the surrounding area.

The procedure is done on an outpatient basis and requires no sutures, so patients no longer need long hospital stays and can return to daily life quickly. Two months after the cryoablation, patients return for an MR to detect any remaining cancer. If cancer were found, the process would be repeated.

“The philosophy of today is surgery first, then radiation. We’re looking at a non-surgical therapy treating a traditional surgery disease,” says Julien. “The mortality data is the best measure of success and it’s very positive. Just looking at breast cancer, it’s all very positive.”

While there’s limited data on breast cancer treatment via cryoablation, Julien thinks it will become a popular choice. “Percutaneous cryoablation therapy is not appropriate in all cases, but for small, low risk tumors, it can sometimes replace tumor removal surgery. Breast preservation and cosmetic appearance are often important factors for women undergoing breast cancer treatment, and compared to surgery, cryoablation preserves breast volume, nipple position and sensation, while avoiding prominent scarring,” he said.

Julien’s colleague Dr. Heather McArthur, breast medical oncologist at Cedars-Sinai Cancer Institute, is conducting clinical trials to test the viability of cryoablation combined with immunotherapy before and after the procedure. Her research treats tumors larger than 15 millimeters in size. Inclusion of immunotherapy seems to be significantly improving patient outcomes. The two are planning a joint clinical trial in the future. ■