Presentation on theme: "Cryotherapy for a spectrum of breast cancer: US and CT-guidance. Peter J. Littrup, M.D. 1* Bassel Jallad, M.D. 1 Priti Chandiwala-Mody, D.O. 2 Monica D’Agostini."— Presentation transcript:
Cryotherapy for a spectrum of breast cancer: US and CT-guidance. Peter J. Littrup, M.D. 1* Bassel Jallad, M.D. 1 Priti Chandiwala-Mody, D.O. 2 Monica D’Agostini 1 Barb Adam, N.P. 1 David Bouwman, M.D. 3 1 Karmanos Cancer Institute 2 Department of Radiology, Wayne State University 3 Department of Surgery, Wayne State University * Co- Inventor/Founder: Single Phase Liquid Cooling (SPLC) by CryoMedix, LLC
Goals & Hypothesis To assess the technical feasibility, patient acceptance, imaging and clinical outcomes of percutaneous cryotherapy for breast cancers. Multiprobe cryoablation for diverse presentations of breast cancer can be monitored to create 1cm visible ice coverage beyond all tumor margins, resulting in thorough cytotoxic coverage.
Introduction: Current treatments for LOCAL Breast Cancer include surgery, radiation and/or chemotherapy Breast Conservation is the primary research focus for new treatment options. Cryotherapy works by delivering lethal cold to ANY cell ~ -30 0 C x 2 cycles Benefits of Cryo? –Much lower pain than heat-based ablations –Easily visualized on CT/US/MR –Excellent Healing ~ Eliminates disfiguring surgery
Introduction: Breast Cryotherapy Research: Single probe Cryotherapy-assisted lumpectomy –Tafra, et al. Ann Surg Oncol. 2003; 10:1018 –1024 Excisional data –Pfleiderer, et al. Invest Radiol. 2005; 40:472-477 –Roubidoux, et al. Imaging: Radiology. 2004; 233:857-867 Conclusions: – 100% kill for all tumors <1 cm & 1-1.5 cm with no DCIS – Unreliable kill for tumors > 1.5 cm – Incomplete along POSTERIOR margins
Materials and Methods: Littrup et al., Lethal Isotherms of Cryoablation in a Phantom Study: Effects of Heat Load, Probe Size, and Number JVIR 2009; 20:1343-1351 Cryotherapy for breast cancer: A feasibility study without excision. J Vasc Interv Radiol 2009; 20:1329–1341. Minimum of 2 probes needed to cover 1cm tumor with lethal ice (< -30°C isotherm) Multiple probes increase lethal ice: Surface area = 55% - 4 probes, 18% - 1 probe Multiple probes and/orMultiple probes and/or Longer freeze timesLonger freeze times correct for: - higher heat loads - lower probe power
Materials & Methods: Patients - Procedures Informed consent included thorough counseling that cryo was NOT standard of care, esp for newly dx potentially curative 14 patients with 27 cancer foci of newly dx or recurrent breast cancer were treated using US and/or CT-guidance Saline injections interposed between the developing ice ball and the skin or chest wall for further thermal protection. Biopsy performed at ice margins immediately after procedure. CT and MRIs were performed in CA patients at available follow-up times, up to 6 years post-procedure.
Cryotherapy for BrCA: Local Recurrence Littrup PJ, et al. JVIR 2009 PreImmediate 1 mo. 18 mo.
Results: Patient Clinical difference – no resection! 14 patients: –7 Locally advanced – on chemo/hormonal tx One had implants – froze into without damage –7 Intent to cure – multifocal + XRT/hormonal Total tumors – 27 Average tumor size – 1.7+ 1.2 cm (range: 0.5-5.8) Minimal distortion – 80-90% resorption 6-12 mo. No localized recurrences –One regional recurrence in breast/axilla
Results: Procedure Average cryoprobes - 3.2 Average ablation size – 51 mm MR planning and follow-up crucial Guidance – 8/14 pts CT and US; 6/14 US only US/CT-guidance superb - operator dependent No complications Minimal discomfort - entirely outpatient Able to address axillary nodes – nerves
Future of Breast Cryotherapy: MR-compatibility Single Phase Liquid Cooling (SPLC)* *CryoMedix, LLC
Vascular/Endoscopic 10 Sec 20 Sec 1 Min 2 Min 20 Thaw
MR - Compatibility MR-monitored breast CA: Cadaver Sagittal (left) and axial views of MR-compatible 1.5 mm cryoprobes at ~1.2mm apart, generating immediate "cold" ice with minimal signal which then thaws over time (right), (sharp initial margins, as well as greater T2 signal with thawing at 15 minutes).
Conclusions Ensure cytotoxic coverage - multiple probes Minimal pain Cosmetic satisfaction – implants OK, breast conservation method Locally curative, control disease process Future: FDA trial with more patients and use of new MRI compatible cryotechnology (operator independence) is being planned