NEW YORK CITY – Image-guided thermal techniques that kill tumors without open surgery or scarring may soon allow women diagnosed with breast cancer to avoid disfigurement to be rid of the disease. "We don't have to deform women in order to destroy their cancer," said Steven A. Harms, M.D., professor of radiology and director of imaging research, University of Arkansas for Medical Sciences in Little Rock.
"I believe this is a treatment that women will begin to demand because it offers everything," Dr. Harms said. "It's an effective outpatient procedure with minimal discomfort that delivers the ultimate cosmetic result: no scars and no deformity."
Ablation therapy utilizes ultrasound or magnetic resonance (MR) imaging to guide a thermal device to the site of a breast tumor. "Ultrasound is an easy guidance method. A high contrast, high resolution MRI is essential for defining the extent of the disease. This is a major revolution. We are seeing and treating breast cancer better than ever before," Dr. Harms said.
There are three types of thermal ablation:
- Radiofrequency ablation treats tumors with heat produced by an electrical current. The radiologist positions the needle-electrodes around the tumor, where a temperature of approximately 60° C (140° F) is applied for 15 minutes to destroy malignant tissue.
- Laser ablation uses a highly concentrated beam of light to penetrate the cancerous tissue. The laser energy is emitted from an optic fiber placed within a needle positioned at the tumor's center by the radiologist.
- Cryotherapy uses liquid nitrogen to freeze and kill abnormal tissue. After numbing the breast tissue around the mass, the radiologist inserts a cryoprobe, which is shaped like a large needle, into the middle of the lesion. An iceball forms at the tip of the probe and continues to grow until the images confirm that the entire tumor has been engulfed, killing the tissue.
Dr. Harms spoke about the procedures today at a Radiological Society of North America (RSNA) media briefing on women's breast health.
"A key advantage of image-guided ablation is that the physician can visualize the ideal treatment zone and effectively destroy the tumor and a margin of tissue surrounding it," Dr. Harms said.
Dr. Harms and physicians at the University of Arkansas for Medical Sciences (UAMS) in Little Rock have performed over 50 thermal ablations on breast cancer patients followed by traditional surgery. Serial section MR images and pathological studies of the breasts indicated that the procedure successfully destroyed all of the cancerous cells.
As a result, UAMS plans to offer thermal ablation as a treatment for solitary small tumors (1.5 centimeters or smaller--about the size of a gumball). Following the procedure, patients typically receive radiation therapy and/or chemotherapy, just as they would following surgical treatment of breast cancer.
"Within a few days or weeks the inflammation goes away. After a year, there's nothing left to see. The patient looks like she did before she developed cancer," Dr. Harms said.
According to Dr. Harms, additional tools, clinical trials and physician training are needed before thermal ablation can become more widespread.
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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