Radiofrequency ablation in the treatment of primary breast cancer: no surgical redundancies yet.
BACKGROUND
Radiofrequency energy has emerged as a new tool for the local destruction of cancer by inducing thermal tissue necrosis in the target region. Radiofrequency ablation (RFA) has recently been used to treat breast cancer primaries, potentially offering all the advantages of minimally invasive techniques.
Nine published studies addressing the role of RFA in the treatment of breast cancer have been identified and analysed, in six, first-line RFA was followed by surgical removal and there were 12 failures in 108 ablations. Three further studies involved RFA without subsequent excision and in 1/60 there was a local relapse after 4 months (follow-up range: 15-29 months).


CONCLUSIONS
Existing RFA techniques may not be able to destroy the whole of the malignant lesion, because of local conditions allowing cancer cells to survive within the target area or because electrodes cannot be accurately directed to the tumour site with ultrasound. Additionally, distant in-breast cancers can be missed on pre/intraoperative imaging. Histological information is unavailable after tissue destruction so that the opportunity to reassess tumour grade based on more extensive sampling is lost, but this can be improved by more extensive sampling with vacuum-assisted core biopsy.


CONCLUSIONS
Before RFA can be safely used in the treatment of breast cancer primaries, several criteria need to be met. These include development of RFA devices and techniques, standardisation of the treatment protocol, including imaging and selection of patients, and establishment of a feasible post-treatment follow-up strategy.
Kontos
M
M
Academic Oncology, Guy's Hospital, London, UK.
Felekouras
E
E
Fentiman
I S
IS
D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D002985:Clinical Protocols; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods; D017211:Treatment Failure