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Kawamoto H, Tsugawa K, Furuya Y, Sakamaki K, Kakimoto S, Kitajima M, Takishita MN, Tazo M, Nakano MH, Kuroda T, Shimo A, Shimo A, Kojima Y, Tsuzuki M, Motoyoshi A, Haku E, Nishikawa T, Kanemaki Y, Mimura H, Fukuda M. Percutaneous ultrasound-guided cryoablation for early-stage primary breast cancer: a follow-up study in Japan. Breast Cancer 2024; 31:695-704. [PMID: 38678120 PMCID: PMC11194206 DOI: 10.1007/s12282-024-01584-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/04/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Ultrasound-guided percutaneous cryoablation (PCA) for early-stage breast cancer (ESBC) can be performed under local anesthesia in an outpatient clinic. This study continues a pilot stage to examine local control, safety, patient quality of life (QoL), satisfaction and cosmetic outcomes of cryoablation for ESBC. METHODS PCA was performed under local anesthesia for patients with primary ESBC, followed by radiation and endocrine therapies. Oncologic outcomes were examined by imaging (mammography, ultrasound, MRI) at baseline and 1, 6, 12, 24, 36, and 60 months post-cryoablation. EQ-VAS, EQ-5D-5L, subjective satisfaction and Moiré topography were used to measure health-related QoL outcomes. RESULTS Eighteen patients, mean aged 59.0 ± 9.0 years, mean tumor size 9.8 ± 2.3 mm, ER + , PR + (17/18), HER2-, Ki67 < 20% (15/18), underwent PCA and were followed for a mean of 44.3 months. No serious adverse events were reported, and no patients had local recurrence or distant metastasis in the 5-year follow-up. Cosmetic outcomes, satisfaction level, and QoL all improved post-cryoablation. Five-year average reduction rates of the cryolesion long, short, and depth diameters, on US, were 61.3%, 42.3%, and 22.8%, respectively, compared to the 86.2% volume reduction rate on MRI. The correlation coefficient between MRI and US measurement criteria was highest for the long diameter. During follow-up, calcification of the treated area was observed in 13/18 cases. CONCLUSION Cryoablation for ESBC is an effective and safe procedure with excellent cosmetic outcomes and improved QoL. This study contributes to the growing evidence supporting cryoablation as a potential standard treatment for ESBC, given compliance to pre-defined patient selection criteria.
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Affiliation(s)
- Hisanori Kawamoto
- Breast and Imaging Center, St. Marianna University School of Medicine, Kawasaki-Shi, Japan.
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki-Shi, Japan.
| | - Koichiro Tsugawa
- Breast and Imaging Center, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
| | - Yuko Furuya
- Breast and Imaging Center, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
| | - Kaori Sakamaki
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
| | - Sayoko Kakimoto
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
| | - Mina Kitajima
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
| | - Mariko Nagai Takishita
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
| | - Mizuho Tazo
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
| | - Mari Hara Nakano
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
| | - Takako Kuroda
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
| | - Ayaka Shimo
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
| | - Arata Shimo
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
| | - Yasuyuki Kojima
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
| | - Makiko Tsuzuki
- Breast and Imaging Center, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
| | - Ai Motoyoshi
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
| | - Ei Haku
- Breast and Imaging Center, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
| | - Toru Nishikawa
- Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
| | - Yoshihide Kanemaki
- Breast and Imaging Center, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
- Department of Diagnostic and Interventional Radiology, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
| | - Hidefumi Mimura
- Department of Diagnostic and Interventional Radiology, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
| | - Mamoru Fukuda
- Breast and Imaging Center, St. Marianna University School of Medicine, Kawasaki-Shi, Japan
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Mactier M, McIntosh SA, Sharma N. Minimally invasive treatment of early, good prognosis breast cancer-is this feasible? Br J Radiol 2024; 97:886-893. [PMID: 38310343 PMCID: PMC11075978 DOI: 10.1093/bjr/tqae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/15/2023] [Accepted: 01/25/2024] [Indexed: 02/05/2024] Open
Abstract
Breast cancer screening programmes frequently detect early, good prognosis breast cancers with significant treatment burden for patients, and associated health-cost implications. Emerging evidence suggests a role for minimally invasive techniques in the management of these patients enabling many women to avoid surgical intervention. Minimally invasive techniques include vacuum-assisted excision, cryoablation, and radiofrequency ablation. We review published evidence in relation to the risks and benefits of each technique and discuss ongoing trials. Data to date are promising, and we predict a trend towards minimally invasive treatment for early, good-prognosis breast cancer as technical skills, suitability criteria, and follow-up protocols are established.
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Affiliation(s)
- Mhairi Mactier
- Golden Jubilee National Hospital, Clydebank G81 4DY, United Kingdom
| | - Stuart A McIntosh
- Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast BT9 7AE, United Kingdom
| | - Nisha Sharma
- Breast Unit, St James Hospital, Leeds LS9 7TF, United Kingdom
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3
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Chua GWY, Li L. Treatment Options for Early Stage Inoperable Breast Cancer: Cryoablation or Radiotherapy? Breast Care (Basel) 2024; 19:106-115. [PMID: 38645759 PMCID: PMC11026071 DOI: 10.1159/000536413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 01/18/2024] [Indexed: 04/23/2024] Open
Abstract
Background Surgical removal of the tumour is the gold standard treatment for early stage invasive breast cancer. However, with a global ageing population, a larger number of diagnoses are occurring in women with comorbidities that render them unsuitable for surgery. Hence, it is of interest to explore alternative treatment strategies for this group of women. Summary Our narrative review aims to explore two such techniques, cryoablation and external beam radiotherapy, providing a brief summary of the evidence behind each technique. Following this, we discuss which groups of patients would gain the most benefit from each technique. Factors favouring the use of radiotherapy include patients with larger tumours, more superficial tumours, and those with less well-demarcated tumours where there is uncertainty regarding tumour extent. Meanwhile, patients who may benefit more from cryoablation include those who desire a smaller number of treatment sessions, have concerns regarding cosmesis and skin pigmentation, or who have relative contraindications to radiotherapy such as scleroderma, systemic lupus erythematosus, reduced lung function, or cardiac comorbidities. Key Messages Continued advancements in both cryoablation and radiotherapy technologies are taking place, in tandem with imaging technologies enabling greater certainty in tumour detection and delineation. These factors will help increase local control rates in this group of non-operable early stage breast cancer patients. Through this review, we hope to aid in the clinical decision-making process regarding the selection and referral of patients for each treatment.
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Affiliation(s)
- Gail Wan Ying Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Lucia Li
- Medical Sciences Division, University of Cambridge, Cambridge, UK
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4
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John D, Gottwald W, Berthe D, Wirtensohn S, Hickler J, Heck L, Herzen J. X-ray dark-field computed tomography for monitoring of tissue freezing. Sci Rep 2024; 14:5599. [PMID: 38454107 PMCID: PMC10920745 DOI: 10.1038/s41598-024-56201-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024] Open
Abstract
Accurately monitoring the extent of freezing in biological tissue is an important requirement for cryoablation, a minimally invasive cancer treatment that induces cell death by freezing tissue with a cryoprobe. During the procedure, monitoring is required to avoid unnecessary harm to the surrounding healthy tissue and to ensure the tumor is properly encapsulated. One commonly used monitoring method is attenuation-based computed tomography (CT), which visualizes the ice ball by utilizing its hypoattenuating properties compared to unfrozen tissue. However, the contrast between frozen and unfrozen tissue remains low. In a proof-of-principle experiment, we show that the contrast between frozen and unfrozen parts of a porcine phantom mimicking breast tissue can be greatly enhanced by acquiring X-ray dark-field images that capture the increasing small-angle scattering caused by the ice crystals formed during the procedure. Our results show that, compared to X-ray attenuation, the frozen region is detected significantly better in dark-field radiographs and CT scans of the phantom. These findings demonstrate that X-ray dark-field imaging could be a potential candidate for improved monitoring of cryoablation procedures.
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Affiliation(s)
- Dominik John
- Research Group Biomedical Imaging Physics, Department of Physics, TUM School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany.
- Chair of Biomedical Physics, Department of Physics, TUM School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany.
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany.
- Institute of Materials Physics, Helmholtz-Zentrum hereon, 21502, Geesthacht, Germany.
| | - Wolfgang Gottwald
- Research Group Biomedical Imaging Physics, Department of Physics, TUM School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Chair of Biomedical Physics, Department of Physics, TUM School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Daniel Berthe
- Research Group Biomedical Imaging Physics, Department of Physics, TUM School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Chair of Biomedical Physics, Department of Physics, TUM School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Sami Wirtensohn
- Research Group Biomedical Imaging Physics, Department of Physics, TUM School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Chair of Biomedical Physics, Department of Physics, TUM School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany
- Institute of Materials Physics, Helmholtz-Zentrum hereon, 21502, Geesthacht, Germany
| | - Julia Hickler
- Research Group Biomedical Imaging Physics, Department of Physics, TUM School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Chair of Biomedical Physics, Department of Physics, TUM School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Lisa Heck
- Research Group Biomedical Imaging Physics, Department of Physics, TUM School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Chair of Biomedical Physics, Department of Physics, TUM School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany
| | - Julia Herzen
- Research Group Biomedical Imaging Physics, Department of Physics, TUM School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Chair of Biomedical Physics, Department of Physics, TUM School of Natural Sciences, Technical University of Munich, 85748, Garching, Germany
- Munich Institute of Biomedical Engineering, Technical University of Munich, 85748, Garching, Germany
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5
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Comen E, Budhu S, Elhanati Y, Page D, Rasalan-Ho T, Ritter E, Wong P, Plitas G, Patil S, Brogi E, Jochelson M, Bryce Y, Solomon SB, Norton L, Merghoub T, McArthur HL. Preoperative immune checkpoint inhibition and cryoablation in early-stage breast cancer. iScience 2024; 27:108880. [PMID: 38333710 PMCID: PMC10850740 DOI: 10.1016/j.isci.2024.108880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/31/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Local cryoablation can engender systemic immune activation/anticancer responses in tumors otherwise resistant to immune checkpoint blockade (ICB). We evaluated the safety/tolerability of preoperative cryoablation plus ipilimumab and nivolumab in 5 early-stage/resectable breast cancers. The primary endpoint was met when all 5 patients underwent standard-of-care primary breast surgery undelayedly. Three patients developed transient hyperthyroidism; one developed grade 4 liver toxicity (resolved with supportive management). We compared this strategy with cryoablation and/or ipilimumab. Dual ICB plus cryoablation induced higher expression of T cell activation markers and serum Th1 cytokines and reduced immunosuppressive serum CD4+PD-1hi T cells, improving effector-to-suppressor T cell ratio. After dual ICB and before cryoablation, T cell receptor sequencing of 4 patients showed increased T cell clonality. In this small subset of patients, we provide preliminary evidence that preoperative cryoablation plus ipilimumab and nivolumab is feasible, inducing systemic adaptive immune activation potentially more robust than cryoablation with/without ipilimumab.
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Affiliation(s)
- Elizabeth Comen
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sadna Budhu
- Ludwig Collaborative and Swim Across America Laboratory, Department of Pharmacology and Mayer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Yuval Elhanati
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Page
- Earle A. Chiles Research Institute, Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR, USA
| | - Teresa Rasalan-Ho
- Immune Monitoring Core Facility, Ludwig Center for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Erika Ritter
- Immune Monitoring Core Facility, Ludwig Center for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Phillip Wong
- Immune Monitoring Core Facility, Ludwig Center for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - George Plitas
- Breast Surgery, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maxine Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yolanda Bryce
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen B. Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Larry Norton
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Taha Merghoub
- Ludwig Collaborative and Swim Across America Laboratory, Department of Pharmacology and Mayer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Heather L. McArthur
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Division of Medical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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6
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Galati F, Marra A, Cicciarelli F, Pasculli M, Maroncelli R, Rizzo V, Moffa G, Pediconi F. Cryoablation for the treatment of breast cancer: immunological implications and future perspectives. Utopia or reality? LA RADIOLOGIA MEDICA 2024; 129:222-228. [PMID: 38296892 PMCID: PMC10879305 DOI: 10.1007/s11547-024-01769-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024]
Abstract
Cryoablation is a minimally invasive technique currently employed in breast cancer care, that uses freeze and thaw cycles to treat benign breast lesions, small breast cancers or focal sites of metastatic disease in patients not eligible for surgery. The final goal of this procedure is to destroy breast cancer cells using extreme cold. In addition, several studies have shown that this technique seems to have an enhancing effect on the immune response, especially by increasing the expression of tumor neoantigens specific to tumor cells, which are then attacked and destroyed. Exploiting this effect, cryoablation in combination with immunotherapy could be the key to treating early-stage breast cancers or patients who are unsuitable for surgery. According to some recent studies, there are other potential tools that could be used to enhance the therapeutic effect of cryoablation, such as FE3O4 nanoparticles or the manipulation of aquaporin expression. The aim of this narrative review is to summarize the current evidence regarding the use, indications, advantages and disadvantages of cryoablation in the treatment of breast cancer.
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Affiliation(s)
- Francesca Galati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Andrea Marra
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Federica Cicciarelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Marcella Pasculli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Roberto Maroncelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Veronica Rizzo
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Giuliana Moffa
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
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7
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Breast Cryoablation: Techniques, Indications, and Challenges. CURRENT RADIOLOGY REPORTS 2023. [DOI: 10.1007/s40134-023-00411-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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8
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Carriero S, Lanza C, Pellegrino G, Ascenti V, Sattin C, Pizzi C, Angileri SA, Biondetti P, Ianniello AA, Piacentino F, Lavorato R, Ierardi AM, Carrafiello G. Ablative Therapies for Breast Cancer: State of Art. Technol Cancer Res Treat 2023; 22:15330338231157193. [PMID: 36916200 PMCID: PMC10017926 DOI: 10.1177/15330338231157193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Breast cancer (BC) is the most frequently diagnosed malignancy among women. In the past two decades, new technologies and BC screening have led to the diagnosis of smaller and earlier-stage BC (ESBC). Therefore, percutaneous minimally invasive techniques (PMIT) were adopted to treat patients unfit for surgery, women who refuse it, or elderly patients with comorbidities that could make surgery a difficult and life-threatening treatment. The target of PMIT is small-size ESBC with the scope of obtaining similar efficacy as surgery. Minimally invasive treatments are convenient alternatives with promising effectiveness, lower morbidity, less cost, less scarring and pain, and more satisfying cosmetic results. Ablative techniques used in BC are cryoablation, radiofrequency ablation, microwave ablation, high-intensity focused ultrasound (US), and laser ablation. The aim of our study is to discuss the current status of percutaneous management of BC, evaluate the clinical outcomes of PMIT in BC, and analyze future perspectives regarding ablation therapy in BC.
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Affiliation(s)
- Serena Carriero
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Carolina Lanza
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Pellegrino
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Velio Ascenti
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Caterina Sattin
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Caterina Pizzi
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Salvatore Alessio Angileri
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, Via Sforza 35, 20122 Milan, Italy
| | - Pierpaolo Biondetti
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, Via Sforza 35, 20122 Milan, Italy.,9304Università Degli Studi di Milano, Milan, Italy
| | | | - Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, Ospedale di Circolo, Varese, Italy
| | - Roberto Lavorato
- Researcher at Diagnostic and Interventional Radiology Department, 9339IRCCS Ca' Granda Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Maria Ierardi
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, Via Sforza 35, 20122 Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, Via Sforza 35, 20122 Milan, Italy.,9304Università Degli Studi di Milano, Milan, Italy
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9
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Olagunju A, Forsman T, Ward RC. An update on the use of cryoablation and immunotherapy for breast cancer. Front Immunol 2022; 13:1026475. [PMID: 36389815 PMCID: PMC9647043 DOI: 10.3389/fimmu.2022.1026475] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/13/2022] [Indexed: 09/10/2023] Open
Abstract
The use of cryoablation, a minimally-invasive image-guided technique to target and kill cancer cells, continues to gain traction within the medical field and with patients. This includes the use of cryoablation for the treatment of small breast cancers and focal sites of metastatic disease. In comparison to open surgical approaches, length of hospital stay and recovery time are decreased with the use of cryoablation. Research studies have also found that cryoablation may actually enhance tumor susceptibility to immunotherapy agents. Immunotherapy enhances a person's own immune system to identify and attack cancer cells. It is proposed that after cryoablation there is increased expression of tumor specific antigens which the body can recognize as foreign invaders and with the combination of immunotherapy, result in an even more robust and efficient attack on the cancer cells. In this review we aim to highlight some of the recent advances in cryoablation which support the potential for cryoablation to induce these tumor-specific immune responses and thus supporting the use of combining cryoablation and immunotherapy for the treatment of breast cancer.
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Affiliation(s)
- Akindele Olagunju
- Department of Diagnostic Imaging, Rhode Island Hospital, Women & Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Tia Forsman
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Robert C. Ward
- Department of Diagnostic Imaging, Rhode Island Hospital, Women & Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, United States
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10
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Pusceddu C, Mascia L, Ninniri C, Ballicu N, Zedda S, Melis L, Deiana G, Porcu A, Fancellu A. The Increasing Role of CT-Guided Cryoablation for the Treatment of Liver Cancer: A Single-Center Report. Cancers (Basel) 2022; 14:cancers14123018. [PMID: 35740682 PMCID: PMC9221264 DOI: 10.3390/cancers14123018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 02/06/2023] Open
Abstract
Purpose: Cryoablation (CrA) is a minimally invasive treatment that can be used in primary and metastatic liver cancer. The purpose of this study was to assess the effectiveness of CrA in patients with hepatocellular carcinoma (HCC) and liver metastases. Methods: We retrospectively evaluated the patients who had CrA for HCC or liver metastases between 2015 and 2020. Technical success, complete ablation, CrA-related complications, local tumor progression, local recurrences, and distant metastases were evaluated in the study population. In patients with HCC, the median survival was also estimated. Results: Sixty-four liver tumors in 49 patients were treated with CrA (50 metastases and 14 HCC). The mean tumor diameter was 2.15 cm. The mean follow-up was 19.8 months. Technical success was achieved in the whole study population. Complete tumor ablation was observed after one month in 92% of lesions treated with CrA (79% and 96% in the HCC Group and metastases Group, respectively, p < 0.001). Local tumor progression occurred in 12.5 of lesions, with no difference between the study groups (p = 0.105). Sixteen patients (33%) developed local recurrence (45% and 29% in the HCC Group and metastases Group, respectively, p = 0.477). Seven patients (14%) developed distant metastases in the follow-up period. Ten patients (20.8%) underwent redo CrA for local recurrence or incomplete tumor ablation. Minor complications were observed in 14% of patients. In patients with HCC, the median survival was 22 months. Conclusions: CrA can be safely used for treatment of HCC and liver metastases not amenable of surgical resection. Further studies are necessary to better define the role of CrA in the multidisciplinary treatment of liver malignancies.
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Affiliation(s)
- Claudio Pusceddu
- Department of Oncological and Interventional Radiology, Oncological Hospital A, Businco, I-09121 Cagliari, Italy; (C.P.); (N.B.); (S.Z.); (L.M.)
| | - Luigi Mascia
- Department of Medical Oncology, Oncological Hospital A, Businco, I-09121 Cagliari, Italy;
| | - Chiara Ninniri
- Unit of General Surgery 2, Clinica Chirurgica, Department of Medical, Surgical, and Experimental Sciences, University of Sassari, I-07100 Sassari, Italy; (C.N.); (G.D.); (A.P.)
| | - Nicola Ballicu
- Department of Oncological and Interventional Radiology, Oncological Hospital A, Businco, I-09121 Cagliari, Italy; (C.P.); (N.B.); (S.Z.); (L.M.)
| | - Stefano Zedda
- Department of Oncological and Interventional Radiology, Oncological Hospital A, Businco, I-09121 Cagliari, Italy; (C.P.); (N.B.); (S.Z.); (L.M.)
| | - Luca Melis
- Department of Oncological and Interventional Radiology, Oncological Hospital A, Businco, I-09121 Cagliari, Italy; (C.P.); (N.B.); (S.Z.); (L.M.)
| | - Giulia Deiana
- Unit of General Surgery 2, Clinica Chirurgica, Department of Medical, Surgical, and Experimental Sciences, University of Sassari, I-07100 Sassari, Italy; (C.N.); (G.D.); (A.P.)
| | - Alberto Porcu
- Unit of General Surgery 2, Clinica Chirurgica, Department of Medical, Surgical, and Experimental Sciences, University of Sassari, I-07100 Sassari, Italy; (C.N.); (G.D.); (A.P.)
| | - Alessandro Fancellu
- Unit of General Surgery 2, Clinica Chirurgica, Department of Medical, Surgical, and Experimental Sciences, University of Sassari, I-07100 Sassari, Italy; (C.N.); (G.D.); (A.P.)
- Correspondence: ; Tel.: +39-079-228432; Fax: +39-079-228394
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An In Vitro Investigation into Cryoablation and Adjunctive Cryoablation/Chemotherapy Combination Therapy for the Treatment of Pancreatic Cancer Using the PANC-1 Cell Line. Biomedicines 2022; 10:biomedicines10020450. [PMID: 35203660 PMCID: PMC8962332 DOI: 10.3390/biomedicines10020450] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 02/01/2023] Open
Abstract
As the incidence of pancreatic ductal adenocarcinoma (PDAC) continues to grow, so does the need for new strategies for treatment. One such area being evaluated is cryoablation. While promising, studies remain limited and questions surrounding basic dosing (minimal lethal temperature) coupled with technological issues associated with accessing PDAC tumors and tumor proximity to vasculature and bile ducts, among others, have limited the use of cryoablation. Additionally, as chemotherapy remains the first-line of attack for PDAC, there is limited information on the impact of combining freezing with chemotherapy. As such, this study investigated the in vitro response of a PDAC cell line to freezing, chemotherapy, and the combination of chemotherapy pre-treatment and freezing. PANC-1 cells and PANC-1 tumor models were exposed to cryoablation (freezing insult) and compared to non-frozen controls. Additionally, PANC-1 cells were exposed to varying sub-clinical doses of gemcitabine or oxaliplatin alone and in combination with freezing. The results show that freezing to −10 °C did not affect viability, whereas −15 °C and −20 °C resulted in a reduction in 1 day post-freeze viability to 85% and 20%, respectively, though both recovered to controls by day 7. A complete cell loss was found following a single freeze below −25 °C. The combination of 100 nM gemcitabine (1.1 mg/m2) pre-treatment and a single freeze at −15 °C resulted in near-complete cell death (<5% survival) over the 7-day assessment interval. The combination of 8.8 µM oxaliplatin (130 mg/m2) pre-treatment and a single −15 °C freeze resulted in a similar trend of increased PANC-1 cell death. In summary, these in vitro results suggest that freezing alone to temperatures in the range of −25 °C results in a high degree of PDAC destruction. Further, the data support a potential combinatorial chemo/cryo-therapeutic strategy for the treatment of PDAC. These results suggest that a reduction in chemotherapeutic dose may be possible when offered in combination with freezing for the treatment of PDAC.
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Wu Y, Cao F, Zhou D, Chen S, Qi H, Huang T, Tan H, Shen L, Fan W. Cryoablation reshapes the immune microenvironment in the distal tumor and enhances the anti-tumor immunity. Front Immunol 2022; 13:930461. [PMID: 36119081 PMCID: PMC9470839 DOI: 10.3389/fimmu.2022.930461] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/15/2022] [Indexed: 02/05/2023] Open
Abstract
As one of the local treatments, cryoablation plays an increasingly important role in the comprehensive treatment of malignant tumors with its advantages of less trauma, high reproducibility, and minimally invasive. Activation of anti-tumor immunity, another characteristic of cryoablation, has attracted more and more attention with the extensive application of immunotherapy. Unfortunately, the mechanism by which cryoablation enhances anti-tumor immunity is still unclear. In this study, we applied a multi-omics approach to investigate the effects of local cryoablation in the distal tumor microenvironment. The results revealed that large amounts of tumor antigens were released post-cryoablation, leading to a sterile inflammatory response in distant tumors. During this period, activated lysosome-related pathways result in over-expression of SNAP23 (Synaptosome associated protein 23) and STXBP2 (Syntaxin binding protein 2), activation of immune effector cells, suppression of the release of immunosuppressive factors, and finally enhancement of anti-tumor immunity, which shows a broad prospect in combined immunotherapy.
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Affiliation(s)
- Ying Wu
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
- Department of Interventional Therapy, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Fei Cao
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Danyang Zhou
- Department of Oncology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Shuanggang Chen
- Department of Oncology, Yuebei People’s Hospital, Shantou University Medical College, Shaoguan, China
| | - Han Qi
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Tao Huang
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Hongtong Tan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Lujun Shen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Weijun Fan, ; Lujun Shen,
| | - Weijun Fan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Weijun Fan, ; Lujun Shen,
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13
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Ma CH, Yang J, Mueller JL, Huang HC. Intratumoral Photosensitizer Delivery and Photodynamic Therapy. ACTA ACUST UNITED AC 2021; 11. [PMID: 34484435 DOI: 10.1142/s179398442130003x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Photodynamic therapy (PDT) is a two-step procedure that involves the administration of special drugs, commonly called photosensitizers, followed by the application of certain wavelengths of light. The light activates these photosensitizers to produce reactive molecular species that induce cell death in tissues. There are numerous factors to consider when selecting the appropriate photosensitizer administration route, such as which part of the body is being targeted, the pharmacokinetics of photosensitizers, and the formulation of photosensitizers. While intravenous, topical, and oral administration of photosensitizers are widely used in preclinical and clinical applications of PDT, other administration routes, such as intraperitoneal, intra-arterial, and intratumoral injections, are gaining traction for their potential in treating advanced diseases and reducing off-target toxicities. With recent advances in targeted nanotechnology, biomaterials, and light delivery systems, the exciting possibilities of targeted photosensitizer delivery can be fully realized for preclinical and clinical applications. Further, in light of the growing burden of cancer mortality in low and middle-income countries and development of low-cost light sources and photosensitizers, PDT could be used to treat cancer patients in low-income settings. This short article introduces aspects of interfaces of intratumoral photosensitizer injections and nano-biomaterials for PDT applications in both high-income and low-income settings but does not present a comprehensive review due to space limitations.
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Affiliation(s)
- Chen-Hua Ma
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, USA
| | - Jeffrey Yang
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, USA
| | - Jenna L Mueller
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, USA.,Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Huang-Chiao Huang
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, USA.,Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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14
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Alkhalifa H, Mohammed F, Taurin S, Greish K, Taha S, Fredericks S. Inhibition of aquaporins as a potential adjunct to breast cancer cryotherapy. Oncol Lett 2021; 21:458. [PMID: 33907568 PMCID: PMC8063341 DOI: 10.3892/ol.2021.12719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/02/2021] [Indexed: 12/20/2022] Open
Abstract
Cryoablation is an emerging type of treatment for cancer. The sensitization of tumors using cryosensitizing agents prior to treatment enhances ablation efficiency and may improve clinical outcomes. Water efflux, which is regulated by aquaporin channels, contributes to cancer cell damage achieved through cryoablation. An increase in aquaporin (AQP) 3 is cryoprotective, whereas its inhibition augments cryodamage. The present study aimed to investigate aquaporin (AQP1, AQP3 and AQP5) gene expression and cellular localization in response to cryoinjury. Cultured breast cancer cells (MDA-MB-231 and MCF-7) were exposed to freezing to induce cryoinjury. RNA and protein extracts were then analyzed using reverse transcription-quantitative PCR and western blotting, respectively. Localization of aquaporins was studied using immunocytochemistry. Additionally, cells were transfected with small interfering RNA to silence aquaporin gene expression and cell viability was assessed using the Sulforhodamine B assay. Cryoinjury did not influence gene expression of AQPs, except for a 4-fold increase of AQP1 expression in MDA-MD-231 cells. There were no clear differences in AQP protein expression for either cell lines upon exposure to frozen and non-frozen temperatures, with the exception of fainter AQP5 bands for non-frozen MCF-7 cells. The exposure of cancer cells to freezing temperatures altered the localization of AQP1 and AQP3 proteins in both MCF-7 and MDA-MD-231 cells. The silencing of AQP1, AQP3 and AQP5 exacerbated MDA-MD-231 cell damage associated with freezing compared with control siRNA. This was also observed with AQP3 and AQP5 silencing in MCF-7 cells. Inhibition of aquaporins may potentially enhance cryoinjury. This cryosensitizing process may be used as an adjunct to breast cancer cryotherapy, especially in the border area targeted by cryoablation where freezing temperatures are not cold enough to induce cellular damage.
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Affiliation(s)
- Haifa Alkhalifa
- Department of Basic Medical Sciences, Royal College of Surgeons in Ireland, Medical University of Bahrain, Adliya 15503, Kingdom of Bahrain
- Department of Science, New York University Abu Dhabi, Abu Dhabi 129188, United Arab Emirates
| | - Fatima Mohammed
- Department of Basic Medical Sciences, Royal College of Surgeons in Ireland, Medical University of Bahrain, Adliya 15503, Kingdom of Bahrain
| | - Sebastien Taurin
- Department of Molecular Medicine, College of Medicine and Medical Sciences, Princess Al-Jawhara Centre for Molecular Medicine, Arabian Gulf University, Segaya, Manama 328, Kingdom of Bahrain
| | - Khaled Greish
- Department of Molecular Medicine, College of Medicine and Medical Sciences, Princess Al-Jawhara Centre for Molecular Medicine, Arabian Gulf University, Segaya, Manama 328, Kingdom of Bahrain
| | - Safa Taha
- Department of Molecular Medicine, College of Medicine and Medical Sciences, Princess Al-Jawhara Centre for Molecular Medicine, Arabian Gulf University, Segaya, Manama 328, Kingdom of Bahrain
| | - Salim Fredericks
- Department of Basic Medical Sciences, Royal College of Surgeons in Ireland, Medical University of Bahrain, Adliya 15503, Kingdom of Bahrain
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15
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Regen-Tuero HC, Ward RC, Sikov WM, Littrup PJ. Cryoablation and Immunotherapy for Breast Cancer: Overview and Rationale for Combined Therapy. Radiol Imaging Cancer 2021; 3:e200134. [PMID: 33817653 DOI: 10.1148/rycan.2021200134] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/17/2020] [Accepted: 12/10/2020] [Indexed: 12/20/2022]
Abstract
Cryoablation is a well-tolerated outpatient procedure that has been used to treat metastatic sites as well as small breast cancers in patients who are considered poor candidates for surgery. Recent studies suggest that cell disruption caused by cryoablation may increase the expression and immunogenicity of tumor neoantigens, which could enhance the ability of the immune system to recognize and attack cancer cells at both local and distant sites. Such an approach might broaden the role of immunotherapy for the treatment of breast cancer, which has previously demonstrated limited response to these agents, likely owing to the modest immunogenicity of most breast cancer subtypes. If cryoablation can induce a systemic tumor-specific response, it could enhance tumor susceptibility to immunotherapy agents. This review briefly summarizes the necessary components for generating an immune response against tumor cells, reviews the tumor microenvironment of breast cancer, describes the rationale for and limitations of immune checkpoint inhibition, highlights the potential for cryoablation to induce a systemic tumor-specific immune response, and describes the rationale for combining cryoablation and immune checkpoint inhibitors for the treatment of breast cancer. Keywords: Ablation Techniques, Breast, Neoplasms-Primary, Percutaneous, Tumor Microenvironment, Tumor Response, Ultrasonography © RSNA, 2021.
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Affiliation(s)
- Helaina C Regen-Tuero
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903 (H.C.R.T., R.C.W.); Department of Diagnostic Imaging, Women and Infants Hospital of Rhode Island, Providence, RI (R.C.W.); Program in Women's Oncology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI (W.M.S.); and Department of Diagnostic Radiology, Wayne State University, Ascension Providence Rochester Hospital, Rochester Hills, Mich (P.J.L.)
| | - Robert C Ward
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903 (H.C.R.T., R.C.W.); Department of Diagnostic Imaging, Women and Infants Hospital of Rhode Island, Providence, RI (R.C.W.); Program in Women's Oncology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI (W.M.S.); and Department of Diagnostic Radiology, Wayne State University, Ascension Providence Rochester Hospital, Rochester Hills, Mich (P.J.L.)
| | - William M Sikov
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903 (H.C.R.T., R.C.W.); Department of Diagnostic Imaging, Women and Infants Hospital of Rhode Island, Providence, RI (R.C.W.); Program in Women's Oncology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI (W.M.S.); and Department of Diagnostic Radiology, Wayne State University, Ascension Providence Rochester Hospital, Rochester Hills, Mich (P.J.L.)
| | - Peter J Littrup
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903 (H.C.R.T., R.C.W.); Department of Diagnostic Imaging, Women and Infants Hospital of Rhode Island, Providence, RI (R.C.W.); Program in Women's Oncology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI (W.M.S.); and Department of Diagnostic Radiology, Wayne State University, Ascension Providence Rochester Hospital, Rochester Hills, Mich (P.J.L.)
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16
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Oxidative Effects during Irreversible Electroporation of Melanoma Cells-In Vitro Study. Molecules 2020; 26:molecules26010154. [PMID: 33396317 PMCID: PMC7796376 DOI: 10.3390/molecules26010154] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/15/2020] [Accepted: 12/28/2020] [Indexed: 12/14/2022] Open
Abstract
Irreversible electroporation (IRE) is today used as an alternative to surgery for the excision of cancer lesions. This study aimed to investigate the oxidative and cytotoxic effects the cells undergo during irreversible electroporation using IRE protocols. To do so, we used IRE-inducing pulsed electric fields (PEFs) (eight pulses of 0.1 ms duration and 2-4 kV/cm intensity) and compared their effects to those of PEFs of intensities below the electroporation threshold (eight pulses, 0.1 ms, 0.2-0.4 kV/cm) and the PEFs involving elongated pulses (eight pulses, 10 ms, 0.2-0.4 kV/cm). Next, to follow the morphology of the melanoma cell membranes after treatment with the PEFs, we analyzed the permeability and integrity of their membranes and analyzed the radical oxygen species (ROS) bursts and the membrane lipids' oxidation. Our data showed that IRE-induced high cytotoxic effect is associated both with irreversible cell membrane disruption and ROS-associated oxidation, which is occurrent also in the low electric field range. It was shown that the viability of melanoma cells characterized by similar ROS content and lipid membrane oxidation after PEF treatment depends on the integrity of the membrane system. Namely, when the effects of the PEF on the membrane are reversible, aside from the high level of ROS and membrane oxidation, the cell does not undergo cell death.
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Snyder KK, Van Buskirk RG, Baust JG, Baust JM. Breast Cancer Cryoablation: Assessment of the Impact of Fundamental Procedural Variables in an In Vitro Human Breast Cancer Model. Breast Cancer (Auckl) 2020; 14:1178223420972363. [PMID: 33239880 PMCID: PMC7672727 DOI: 10.1177/1178223420972363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/12/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Breast cancer is the most prominent form of cancer and the second leading cause of death in women behind lung cancer. The primary modes of treatment today include surgical excision (lumpectomy, mastectomy), radiation, chemoablation, anti-HER2/neu therapy, and/or hormone therapy. The severe side effects associated with these therapies suggest a minimally invasive therapy with fewer quality of life issues would be advantageous for treatment of this pervasive disease. Cryoablation has been used in the treatment of other cancers, including prostate, skin, and cervical, for decades and has been shown to be a successful minimally invasive therapeutic option. To this end, the use of cryotherapy for the treatment of breast cancer has increased over the last several years. Although successful, one of the challenges in cryoablation is management of cancer destruction in the periphery of the ice ball as the tissue within this outer margin may not experience ablative temperatures. In breast cancer, this is of concern due to the lobular nature of the tumors. As such, in this study, we investigated the level of cell death at various temperatures associated with the margin of a cryogenic lesion as well as the impact of repetitive freezing and thawing methods on overall efficacy. METHODS Human breast cancer cells, MCF-7, were exposed to temperatures of -5°C, -10°C, -15°C, -20°C, or -25°C for 5-minute freeze intervals in a single or repeat freeze-thaw cycle. Samples were thawed with either passive or active warming for 5 or 10 minutes. Samples were assessed at 1, 2, and 3 days post-freeze to assess cell survival and recovery. In addition, the modes of cell death associated with freezing were assessed over the initial 24-hour post-thaw recovery period. RESULTS Exposure of MCF-7 cells to -5°C and -10°C resulted in minimal cell death regardless of the freeze/thaw conditions. Freezing to a temperature of -25°C resulted in complete cell death 1 day post-thaw with no cell recovery in all freeze/thaw scenarios evaluated. Exposure to a single freeze event resulted in a gradual increase in cell death at -15°C and -20°C. Application of a repeat freeze-thaw cycle (dual 5-minute freeze) resulted in an increase in cell death with complete destruction at -20°C and near complete death at -15°C (day 1 survival: single -15°C freeze/thaw = 20%; repeated -15°C freeze/thaw = 4%). Analysis of thaw interval time (5 vs 10 minute) demonstrated that the shorter 5-minute thaw interval between freezes resulted in increased cell destruction. Furthermore, investigation of thaw rate (active vs passive thawing) demonstrated that active thawing resulted in increased cell survival thereby less effective ablation compared with passive thawing (eg, -15°C 5/10/5 procedure survival, passive thaw: 4% vs active thaw: 29%). CONCLUSIONS In summary, these in vitro findings suggest that freezing to temperatures of 25°C results in a high degree of breast cancer cell destruction. Furthermore, the data demonstrate that the application of a repeat freeze procedure with a passive 5-minute or 10-minute thaw interval between freeze cycles increases the minimal lethal temperature to the -15°C to -20°C range. The data also demonstrate that the use of an active thawing procedure between freezes reduces ablation efficacy at temperatures associated with the iceball periphery. These findings may be important to improving future clinical applications of cryoablation for the treatment of breast cancer.
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Affiliation(s)
| | - Robert G Van Buskirk
- CPSI Biotech, Owego, NY, USA
- Center for Translational Stem Cell and Tissue Engineering, Binghamton University, Binghamton, NY, USA
- Department of Biological Sciences, Binghamton University, Binghamton, NY, USA
| | - John G Baust
- Center for Translational Stem Cell and Tissue Engineering, Binghamton University, Binghamton, NY, USA
- Department of Biological Sciences, Binghamton University, Binghamton, NY, USA
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Plaza MJ, Cole DA. Could ultrasound-guided cryoablation be used to manage "low-risk" DCIS?: a feasibility case report. Radiol Case Rep 2020; 15:1301-1304. [PMID: 32595816 PMCID: PMC7306537 DOI: 10.1016/j.radcr.2020.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 11/29/2022] Open
Abstract
Management of ductal carcinoma in-situ (DCIS) is controversial as there is concern that the majority of diagnoses will never become life threatening such that a subset of patients may be overtreated with surgery. Active surveillance is an alternative proposed management strategy; however, we cannot accurately predict which DCIS will never progress to invasive disease potentially undertreating a large proportion of women. We present a case of a 58-year-old female with DCIS successfully treated with only ultrasound-guided cryoablation without resection. A follow-up needle biopsy of the ablation zone was benign and imaging follow-up has demonstrated no evidence of disease at 14-months. Cryoablation of DCIS is feasible with appropriate patient selection and warrants further investigation as an alternative to surgical resection or active surveillance.
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Affiliation(s)
- Michael J. Plaza
- Diagnostic Center for Women, LLC, 7500 SW 87th Ave, Suite 100, Miami, FL 33173 USA
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