Long-term results of excision followed by radiofrequency ablation as the sole means of local therapy for breast cancer.
BACKGROUND
Clinical trials have yet to find a size or grade of invasive cancer which can be treated with lumpectomy alone due to the higher local recurrence (LR) rate without radiation (XRT). Excision followed by radiofrequency ablation (eRFA) is an intraoperative method which utilizes heat to create an additional tumor-free zone around the lumpectomy cavity. We hypothesized that eRFA after lumpectomy for invasive breast cancer could reduce the need for re-excision in close margins and potentially maintain local control without the need for XRT.


METHODS
This institutional review board-approved study from July 2002 to December 2010 involved patients undergoing eRFA. A standard lumpectomy was performed and then the RFA probe was deployed 1 cm circumferentially into the walls of the lumpectomy cavity and maintained at 100 °C for 15 min. Validated doppler sonography was used to determine final ablation size.


RESULTS
Seventy-three patients (mean age of 68.8 ± 10.9 years) with invasive cancer who had an average tumor size of 1.0 ± 0.54 cm (range of 0.2-2.6 cm) underwent eRFA. Margins were negative in 54, close in 10, focally positive in 6, and grossly positive in 3 patients. Sixteen out of 19 (84 %) of patients with close or positive margins were spared of re-excision. Median follow-up was 55 ± 21 months. Only one patient (1.3 %) developed an in site recurrence. There were three recurrences, elsewhere.


CONCLUSIONS
Long-term follow-up suggests that eRFA may reduce the need for re- excision as well as reduce LR for invasive breast cancer treated without XRT.
Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Misti
M
Wilson
Soheila
S
Korourian
Cristiano
C
Boneti
Laura
L
Adkins
Brian
B
Badgwell
Jeannette
J
Lee
V
V
Suzanne Klimberg
D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018275:Carcinoma, Lobular / Q000401:mortality / Q000473:pathology / Q000601:surgery; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D011379:Prognosis; D015996:Survival Rate