Cryoablation is a promising, cost-effective option to de-escalate surgical breast cancer morbidity, but presently is only suggested for breast cancers < 1.5 cm, in select candidates. Breast cancer cryoablation is not a reliably covered procedure by insurance and is mainly guided by ultrasound (US), using a single cryoprobe. Yet, cryoablation is an accepted treatment option for various malignancies, including those of the kidney, liver and lung, utilizing a predominantly CT-guided, multi-probe approach using crucial cytotoxic isotherms for thorough tumor coverage. Cryoablation thus continues to find new clinical utility and is rapidly advancing on multiple fronts, similar to immunotherapy. Clinical concerns of expanding cryoablation to breast tumors > 1.5 cm is more related to the greater risk of metastatic spread to local lymph nodes and beyond. Combined adjuvant treatment, such as radiation and/or chemotherapy, are currently used for regional and systemic breast cancer control, but have significant associated morbidities. US/CT-guided multi-probe large-volume breast cryoablation is presented as a thorough local control option for select patients. Intratumoral chemotherapy by direct tumor injection has been shown to be safe and is currently being tested with immunotherapy drugs and exhibits much lower morbidity. Cryoablation combined with intratumoral immunotherapy is presented to show robust systemic immune response and the potential to provide additional protection from regional and/or metastatic disease spread while de-escalating the morbidities from current adjuvant treatments for larger breast cancers. While further clinical trials are needed, it is essential to pursue safe and effective breast cancer treatments that offer the potential for cost-efficiency and therapeutic de-escalation across a wide spectrum of breast cancer cases.
冷冻消融是一种有望降低乳腺癌手术并发症且成本效益良好的治疗选择，但目前仅建议用于特定患者中直径小于1.5厘米的乳腺癌。该技术尚未被医保系统稳定覆盖，且主要依赖超声引导下的单探针操作。然而，冷冻消融作为成熟的肿瘤治疗手段，已广泛应用于肾脏、肝脏及肺部等多种恶性肿瘤的治疗，其典型模式采用CT引导的多探针布局，通过关键细胞毒性等温线实现肿瘤的彻底覆盖。与免疫疗法相似，冷冻消融技术正持续拓展新的临床应用领域，并在多个维度快速发展。 将冷冻消融技术扩展至直径大于1.5厘米的乳腺肿瘤时，临床主要担忧在于肿瘤向区域淋巴结及远处转移的风险增高。目前临床采用放疗和/或化疗等联合辅助治疗手段进行区域性和全身性控制，但这些疗法常伴随显著并发症。本文提出超声/CT引导的多探针大体积乳腺冷冻消融术，为特定患者提供彻底的局部控制方案。瘤内直接注射化疗药物已被证实具有安全性，目前正与免疫治疗药物联合测试，且显示并发症发生率显著降低。 研究表明，冷冻消融联合瘤内免疫治疗能激发强烈的全身免疫应答，不仅可能为区域性及转移性病灶扩散提供额外防护，同时可降低当前针对较大乳腺癌辅助治疗产生的并发症。尽管仍需进一步临床试验验证，但探索安全有效的乳腺癌治疗方案至关重要，这些方案应具备成本效益优势，并能在广泛乳腺癌病例中实现治疗降级。
肿瘤(癌症)患者之家