Put It on Ice: This freezing technique is a promising cancer treatment

When treating cancer the best alternative treatments are those that are minimally invasive. The less a person’s insides are exposed, the better.

Unfortunately, in the mainstream medical community that often means radiation. But blasting the body’s cells with radiation often causes more harm than good, as healthy cells and cancer cells alike are exposed to the toxic treatment.

There’s new hope, however.

A much less invasive treatment is getting up a head of steam. It requires only local anesthetic, can be performed as an outpatient procedure and has less downtown than conventional cancer treatment methods.

Read on to discover this technique and how it’s changing the face of cancer treatment.

 

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This technique is called cryoablation. The word itself breaks down as “ablation,” which means to destroy or remove, and the prefix “cryo,” which refers to freezing.

 

What is cryoablation?

When a doctor performs cryoablation, she uses ultrasound imaging to help her guide a thin, needle-like device into the patient’s tumor. Once inside it injects liquid nitrogen into the tumor, which then destroys the cancerous cells.

The process is much less invasive than traditional surgery and is most often done in an outpatient setting with local anesthesia only.

This is especially good for older patients, as the risk of cognitive impairment after general anesthesia increases with age (click here for more information about the link between anesthesia and dementia).

Older adults and people with more serious medical conditions may also be at an increased risk of developing postoperative pneumonia, strokes or heart attacks after undergoing general anesthesia.(1) Not to mention the usual side effects of general anesthesia such as nausea, vomiting and shivering.

And, the risk of developing cancer increases with age, so finding nonsurgical methods of treating this disease in people of advanced age is important.

 

Cryoablation for treating many kinds of breast cancer

Cryoablation has been used for years in treating early stage cancers of the liver, lung and kidney. It’s also been used in treating non-cancerous fibroids in the breast and uterus.

A study published by the British Institute of Radiology notes that breast cancer is a major source of morbidity and mortality in the elderly, and the number of patients is expected to increase by 30% in future decades.(2)

Taking this fact into consideration alongside the concerns around anesthesia and older patients, they performed a study to see if cryoablation could be an adequate substitution for surgery.

Four patients aged 79 to 82 who were recommended for surgery underwent ultrasound-guided cryoablation instead. After a follow-up period of 29 months all patients were still alive and without any other signs of recurrence or metastases.

The study concluded that cryoablation “is safe and feasible in the management of breast cancer in elderly patients.(2)

 

Malignant Breast Tumors

Ductal breast cancer starts in the milk ducts and, according to breastcancer.org, about 80% of breast cancers are of this type, making it the most common kind of breast cancer. Invasive ductal breast cancer (IBC) means the cancer has spread to the surrounding tissue. Over time it can spread to the lymph nodes and other areas of the body.(3)

A study published in 2016 in the Annals of Surgical Oncology finds that cryoablation may also be a viable treatment option for treating ductal breast cancers in the early stage.

In the study, 99 breast cancer patients with invasive ductal breast cancer (IBC) of 2 centimeters or greater and/or patients with 25% or greater ductal carcinoma in situ (DCIS) were treated with cryoablation in 19 different facilities.

The researchers used MRI to evaluate any residual IBC or DCIS after treatment and found that cryoablation had a 75.9% success rate in destroying cancer cells in the targeted areas.(4)

 

Triple-Negative Breast Cancer

Only about 15-20% of diagnosed breast cancers are what’s called “triple negative breast cancer” (TNBC).

All breast tumors are tested for certain receptors, or proteins: estrogen receptors, progesterone receptors and HER2/neu receptors.

When a tumor has few to no receptors it’s “negative.” When it has few to none of any of these receptors, it’s triple negative.

There are fewer treatment options for “negative” tumors than there are for “positive” tumors because most treatment is designed around targeting these receptors, such as hormone therapy.

TNBC also tends to be more aggressive, growing faster than other kinds of breast cancer and generally has a poorer prognosis.(5)

This is partly attributed to the fact that TNBC produces a certain cytokine (cell signaling protein) called interleukin-6 that inhibits T-cell response in the tumor microenvironment. Because of this the immune system becomes incapable of addresses the cancer cells.

However, new cryoablation research shows promise in treating this type of breast cancer.

One study, published in 2015 in the journal OnoImmunology, tested the use of cryoablation combined with Meriva, a patented formulation of curcumin and soy lecithin that allows for greater bioavailability, on mice with metastatic breast cancer.

Researchers performed cryoablation on the tumor and then followed up with an injection of Meriva into the tumor.

The researchers discovered this combination activated certain T-cells to multiple tumor-associated antigens (foreign bodies that prompt the immune system to respond). This resulted in a near complete reduction of primary tumors and lung metastases.

According to the study, “the survival rate in the group of cryoablation plus Meriva was significantly improved compared to all control groups” (Meriva alone, cryoablation alone or groups receiving saline control).(6)

For example, 58 days after treatment, mice receiving only cryoablation developed metastases in the lungs, while those that received cryoablation plus Meriva were free of metastases.

 

Cryoablation for bone cancer

In addition to treating early-stage breast cancer tumors, cryoablation has shown success in easing the pain of patients suffering from soft tissue cancer and bone metastases.

One study, begun in 2011 and published in 2016, analyzed the use of CT-guided cryoablation for malignant bone and soft tissue tumors.

There were 9 patients and a total of 11 CT-guided cryoablation procedures were performed. Patients in the study had a variety of cancers ranging from renal cell carcinoma to sarcomas to thyroid carcinoma. They suffered from either recurrent tumors or metastases.

All patients, for one reason or another, were unable to elect surgery, chemotherapy or radiotherapy as treatment options.

They underwent 2 to 3 rounds of cryoablation, and at the end of the 24-month follow-up period, 4 patients showed no evidence of disease, 2 were alive with disease and 3 had died of disease.(7)

 

Cryoablation for palliative care in bone cancer

When cancer spreads to the bones it can be very painful. The traditional routes of easing this pain have been chemotherapy, analgesics and narcotics, and localized radiation therapy. For many patients their pain is nonresponsive to these treatments.

A 2016 study published in Current Orthopedic Practice found that minimally invasive procedures like cryoablation are a viable modality for palliative care in patients with bone pain caused by metastases.

The study found that cryoablation relieved pain in the patients and narcotic usage declined.(8)

While the researchers are the first to admit that more studies must be done to determine how far cryoablation can be used in the treatment of cancers, the initial studies have been promising.

From reducing the number of surgeries to decreasing narcotic dependence, cryoablation may not be a cure-all, but it’s establishing a place as a viable alternative treatment in the cancer treatment landscape.

 

Best Regards,

Lee Euler
Publisher

 

References:

  1. General anesthesia, risks. http://www.mayoclinic.org/tests-procedures/anesthesia/details/risks/cmc-20163587
  2. Ultrasound-guided percutaneous radiofrequency ablation in elderly breast cancer patients: Preliminary institutional experience. http://www.birpublications.org/doi/abs/10.1259/bjr/91383984?journalCode=bjr
  3. IDC – Invasive ductal carcinoma. http://www.breastcancer.org/symptoms/types/idc
  4. A phase II trial exploring the success of cryoablation therapy in the treatment of invasive breast carcinoma: Results from ACOSOG (Alliance) Z1072. https://www.ncbi.nlm.nih.gov/pubmed/27221361
  5. Triple negative breast cancer. Susan G. Komen. https://ww5.komen.org/uploadedFiles/_Komen/Content/About_Breast_Cancer/Tools_and_Resources/Fact_Sheets_and_Breast_Self_Awareness_Cards/Triple%20Negative%20Breast%20Cancer.pdf
  6. Cryoablation and Meriva have strong therapeutic effect on triple-negative breast cancer. http://www.tandfonline.com/doi/abs/10.1080/2162402X.2015.1049802
  7. CT guided cryoablation for locally recurrent or metastatic bone and soft tissue tumor: Initial experience. https://bmccancer.biomedcentral.com/articles/10.1186/s12885-016-2852-6
  8. Minimally invasive techniques for pain palliation in extraspinal bone metastases: A review of conventional methods and cryoablation. http://journals.lww.com/c-orthopaedicpractice/Abstract/2016/09000/Minimally_invasive_techniques_for_pain_palliation.13.aspx