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

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

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