title: eRFA: excision followed by RFA-a new technique to improve local control in breast cancer.
abstract: BACKGROUND
  Excision followed by RFA (eRFA) may allow improved cosmesis while ensuring negative margins in patients with breast cancer. This technique utilizes heat to create an additional tumor-free zone around the lumpectomy cavity. We hypothesized that eRFA will decrease the need for re-excision of inadequate margins.
  
  
  METHODS
  Between July 2002 and January 2005, we conducted a multiphase trial of RFA of prophylactic mastectomy specimens and of women desiring lumpectomy. In both models, a lumpectomy was performed, the RFA probe was deployed 1 cm circumferentially into the walls of the lumpectomy cavity and maintained at 100 degrees C for 15 min. Whole mount slides were used to measure the zone of ablation for ex vivo specimens. Hematoxylin and eosin staining of in vivo lumpectomy margins < 3 mm was considered inadequate.
  
  
  RESULTS
  Nineteen prophylactic mastectomy ablations revealed a consistent perimeter of ablation. Forty-one patients (mean age 63 +/- 14 years) had an average tumor size of 1.6 +/- 1.5 cm underwent in vivo eRFA, and 25% had inadequate margins: one focally positive, one < 2 mm, eight < 1 mm and one grossly positive. Only the grossly positive margin was re-excised. Overall complication rate of in vivo ablations was 7.5%. Twenty-four of 41 patients did not have post-eRFA XRT. No in-site local recurrences have occurred during a median follow-up of 24 months (12-45 months). Two patients have occurred elsewhere.
  
  
  CONCLUSIONS
  The ex vivo ablation model reliably created a 5-10 mm perimeter of ablation. In vivo, this zone reduced the need for re-excision for inadequate margins by 91% (10/11). Short-term follow-up suggests that eRFA could reduce re-excision surgery and local recurrence.
authors.affiliation: Department of Surgery, Division of Breast Surgical Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA. klimbergsuzanne@uams.edu
authors.forename: V Suzanne
authors.initials: VS
authors.lastname: Klimberg
authors.forename: Julie
authors.initials: J
authors.lastname: Kepple
authors.forename: Gal
authors.initials: G
authors.lastname: Shafirstein
authors.forename: Laura
authors.initials: L
authors.lastname: Adkins
authors.forename: Ronda
authors.initials: R
authors.lastname: Henry-Tillman
authors.forename: Emad
authors.initials: E
authors.lastname: Youssef
authors.forename: Jorge
authors.initials: J
authors.lastname: Brito
authors.forename: Lori
authors.initials: L
authors.lastname: Talley
authors.forename: Soheila
authors.initials: S
authors.lastname: Korourian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000517:prevention & control / Q000532:radiotherapy* / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D016896:Treatment Outcome