eRFA: excision followed by RFA-a new technique to improve local control in breast cancer.
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.
Klimberg
V Suzanne
VS
Department of Surgery, Division of Breast Surgical Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA. klimbergsuzanne@uams.edu
Kepple
Julie
J
Shafirstein
Gal
G
Adkins
Laura
L
Henry-Tillman
Ronda
R
Youssef
Emad
E
Brito
Jorge
J
Talley
Lori
L
Korourian
Soheila
S
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