In Situ Ablation of Breast Tumors - for Amber and everyone

[Guest guest]

In Situ Ablation Of Breast Tumors. What Is The State Of The Art?

Article by S. Sabel, MD

Assistant Professor of Surgery

University of Michigan Comprehensive Cancer Center

Published online May 2002

Introduction:

The treatment of breast cancer through the majority of the twentieth century

was the radical mastectomy; the removal of the entire breast, the overlying

skin, the underlying muscles and all of the lymph nodes underneath the arm. This

operation was very disfiguring, had significant side effects, and while it

prevented local recurrence (the chance of the cancer returning on the chest

wall), it failed to cure many patients. Since that time, the treatment of breast

cancer has shifted away from mastectomy and towards removing just the cancer,

leaving the normal breast tissue intact. It was discovered that following a

lumpectomy (where just the tumor is removed with a margin of normal tissue) with

radiation to the breast resulted in a low rate of local recurrence, almost as

low as with a mastectomy. This led to a very large study in the United States

involving nearly 2000 women that demonstrated that a lumpectomy plus radiation

was equivalent to a mastectomy. These results were verified by trials around

the world, and in 1990 the National Institutes of Health recommended that

breast-conservation therapy was the appropriate method of primary surgery for

most

women with early breast cancer. The importance of breast conservation as an

alternative to mastectomy has grown dramatically as more women have tumor

detected at a smaller size with the increased use of screening mammography.

Advances in imaging, such as digital mammography, ultrasound and magnetic

resonance imaging (MRI) have improved our ability to both visualize smaller

breast tumors and biopsy them without the need for surgery. This is known as a

stereotactic biopsy. The next logical step in the treatment of breast cancer is

the ability to treat tumors in a similar manner, without the need for surgical

resection. Lumpectomy, while significantly better than mastectomy, can still

leave a cosmetic defect and requires a trip to the operating room. Several new

techniques are being studied where a probe is placed through a small incision

in the skin, into the center of a tumor, and used to destroy all of the breast

cancer cells by either heating or freezing them. This is referred to as in

situ ablation. Some methods for ablation can potentially destroy the cancer

cells

from the outside, without even the need to place a probe through a skin

incision. Early studies have shown that these techniques can be performed

without

sedation, with minimal to no discomfort to the patient and very few side

effects. More importantly, they can completely destroy the tumor while leaving

the

remainder of the breast intact, resulting in excellent cosmetic results. This

article will describe some of the techniques being used to destroy tumors in

the breast. However, it is important to stress that all of these approaches are

experimental, and there is minimal experience to date with them. The standard

of care for breast cancer is still surgical resection, and no woman should be

treated by any of these methods outside of a research study. Hopefully,

however, if enough women agree to participate in this research, in situ ablation

may

soon replace lumpectomy as the treatment for early-stage breast cancer.

Radiofrequency Ablation:

Radiofrequency ablation (RFA) delivers an electrical current to the tumor

tissues, which causes them to vibrate rapidly and create frictional heating.

Using ultrasound, a surgeon can place a probe at the center of a tumor, and then

small prongs are deployed around it (like an umbrella). The probe is connected

to a generator and the electrical current raises the temperature at the site

to 95 degrees Celcius and maintained for about 15 minutes. This is used quite

commonly in the treatment of tumors in the liver, and is now being studied in

the breast. Several studies are ongoing at the University of Texas MD

Cancer Center, Weill Cornell Breast Center and Wayne Cancer Institute

where women with breast cancer underwent destruction of their tumors by RFA and

then had standard surgery. The patients tolerated the procedure very well, with

very few side effects. When they looked at the tissue after surgical

resection, almost all the tumors had been completely destroyed by RFA. Plans are

underway to begin a study at MD Cancer Center where breast cancers are

ablated with RFA followed by radiation therapy without surgical resection.

Laser Therapy:

Lasers can also be used to heat and destroy tumors while still in the breast.

A fiberoptic cable can be placed within a tumor using either stereotactic

guidance (similar to when a biopsy is performed) or MRI. At the tip of the cable

is a diffusing quartz. Light energy from the laser is passed through the cable

and the resulting heat can destroy a sphere surrounding tissue around the

laser tip. The amount of laser energy needed to be sure to destroy the tumor can

be calculated based on size of the tumor, including a 0.5 cm margin of normal

breast tissue. The procedure has been performed safely with minimal pain. Like

with RFA, after the breast cancers were destroyed by laser, they were

surgically resected and examined by a pathologist. Complete destruction of the

tumor

was shown in a majority of patients, however several patients had breast

cancer cells that were still present at the time of surgery. Research is ongoing

at

Rush-Presbyterian-St. Luke’s Hospital and the University of Arkansas to

improve the ability of laser ablation to destroy 100% of tumors.

Cryosurgery:

As opposed to radiofrequency ablation or laser therapy, which use heat to

destroy tumors, cryosurgery utilizes freezing temperatures to destroy cancer

cells. Cryosurgery has actually been looked at as a method to treat advanced

breast cancers for many years. Likewise, it has been a standard method of

treating

skin lesions. Advances in technology, specifically the development of a thin

probe that can freeze lesions deeper in the body, has paved the way for

cryosurgery to be used to treat cancers in the liver or prostate. It is also be

studied as a method to treat early stage breast cancers. Using ultrasound

guidance,

a cryoprobe- essentially a large needle with a tip that gets extremely cold-

is placed into the lesion (see Figure 1).

Figure 1

Using ultrasound guidance, the cryoprobe is placed through a small incision

in the skin so that it sits at the center of the breast cancer.

An ice ball forms around the tumor, and the surgeon can watch this using

ultrasound (see figure 2).

Figure 2

The tip of the cryoprobe gets extremely cold, causing an iceball to form

around the cancer. This destroys the cancer, and can be visualized with

ultrasound. After freezing the cancer twice, the probe is removed and a Band-Aid

is

placed over the skin incision.

Typically the tumor is frozen, thawed, and then frozen again before removing

the probe. Studies where cryosurgery was performed followed by surgical

resection have shown that complete tumor death could be obtained when small

tumors

were frozen in this method. In addition to the excellent cosmetic results seen

with cryosurgery, there is some evidence that freezing tumors can stimulate

the immune system to destroy cancer cells elsewhere in the body. If this is

true, then cryosurgery may hold benefits beyond destruction of the local tumors.

Ongoing studies at The University of Michigan are examining both the

feasibility of cryosurgery to completely destroy early stage breast cancers and

stimulate an immune response.

Focused Ultrasound and Microwave Thermotherapy:

Radiofreqency, laser and cryoablation all require the placement of a probe

within the tumor to achieve their results. Therefore they are referred to as “

minimally invasive.†Newer technologies are being investigated for the

treatment

of breast cancer that are truly non-invasive. This means that no probe needs

to placed into the center of the tumor, but rather the tumors can be heated

from outside the breast.

One method for doing this is called high-intensity focused ultrasound (FUS).

When used for imaging, ultrasound consists of a wide field of high-frequency

sound waves being bounced off the tissues in your body. However when these

ultrasound beams are focused intensely at one spot, they can heat the tissues.

Early trials have shown this method can be used to treat early stage breast

cancers with impressive results. For women with breast cancer, several

transducers

placed around the breast deliver high intensity focussed ultrasound to heat

the tumor while other transducers use ultrasound to guide and monitor the

process. With the improved three-dimensional soft tissue imaging of MRI, other

researchers are finding they can very accurately destroy tumors with FUS while

allowing for minimal destruction of normal tissue. FUS is presently being

studied

at the Brigham and Women’s Hospital in Boston and at the University of Texas

MD Cancer Center.

Another truly non-invasive method for the in situ ablation of breast cancer

is Focused Microwave Thermotherapy (FMT). Based on technology originally

developed to detect and destroy an enemy missile (known as the Strategic Defense

Initiative or the Star Wars plan), it was discovered that this technology could

also be used to treat cancer cells. This technology takes advantage of the

difference in water content between normal cells and cancer cells. Patients lie

on

their stomachs and place their breast through a hole in the table. FMT can

then be used to heat tumors without burning the skin. Both focused ultrasound

and microwave thermotherapy are new technologies, and much more research is

necessary to determine if breast cancers can effectively be treated in this

manner. However, early results are promising and ongoing research is being done

at

Columbia Hospital in Florida, UCLA Medical Center and Massachusetts General

Hospital.

Future Directions:

In situ ablation holds tremendous potential as a treatment for early-stage

breast cancer. Early studies have shown that each of the methods discussed can

be performed safely, with little discomfort to the patient and minimal side

effects. After being destroyed, the dead tissue is absorbed by the body, leaving

a normal appearing breast without a scar. The procedures can usually be done

without intravenous sedation, so many women could potentially be treated in the

office without the need for a trip to the operating room. This would greatly

improve the cost and convenience of breast cancer treatment.

However, it is important to stress that these are experimental therapies, and

many questions still exist. When removing a tumor surgically, the pathologist

can tell the surgeon if he or she has removed the entire tumor (“negative

marginsâ€). The surgeon can go back and remove more tissue if necessary. When

the

tumor is destroyed in place, without surgical excision, new methods are

necessary to determine afterwards if the entire tumor has been destroyed. In

addition, there is not enough known about how these procedures may affect

subsequent

mammograms. This may make it difficult to look for recurrences in the years

after treatment. Additional research is necessary to answer these questions.

It is also important to bear in mind that surgery is still the “gold

standardâ€

for the treatment of breast cancer, and for cancers detected at an early

stage, the results are excellent. With lumpectomy and radiation for small

tumors,

recurrence rates are low and survival is high. And while there may be some

cosmetic alteration, usually women are very pleased with the appearance of the

breast after lumpectomy and radiation. Studies with thousands of women,

followed for many years, will be necessary to show that the results with in situ

ablation are just as good before it can replace surgery as first line therapy.

It is too early to say which method will be the “state of the art†for

breast cancer ablation. It is most likely that different techniques may be

necessary for different patients. Each of these techniques holds tremendous

potential,

and continued research is crucial. At this time, most of the on-going trials

consist of in situ ablation followed by standard surgical resection. It is

important for women to participate in these studies, for this information will

hopefully allow women in the near future to have their breast cancers treated

without surgical excision.

Published online in May 2002

S. Sabel, MD

Assistant Professor of Surgery

University of Michigan Comprehensive Cancer Center

Ann Arbor, MI 48109

[Guest guest]

> Radiofrequency Ablation:

> Radiofrequency ablation (RFA) delivers an electrical current to the

tumor

> tissues, which causes them to vibrate rapidly and create frictional

heating.

Hi Deva,

Thank you for posting this article...it is among the best that I have

seen in my five years of researching this disease.

As I type this, I am treating myself to similar technology in my own

home using radio frequencies via a Hulda zapper. No doctors,

no hospitals, no waiting, no invasiveness, and once I purchased the

zapper, no expense.

I can (and do, daily) direct the current from the zapper to

infinitisemally small areas of my body...say, to only the white blood

cells inside the arteries which are inside a tumor which is in the

left breast.

With a zapper there is no heating, and no killing of cells. There is

a temporary superactivation of white blood cells and subsequent

removal of toxins and organisms from the area zapped. The elegance

of this, is that the white blood cells decide what to phagocytize, or

remove.

At the moment, I am directing the 9 volts of dc current at a

frequency of 30,000 Hz, through copper tube electrodes under my feet

to the arteries, veins and capillaries in my left adrenal gland.

This is an amazing technology.

Love,

[Guest guest]

Is this similar to the rife machine?

[ ] Re: In Situ Ablation of Breast Tumors - for Amber and

everyone

> Radiofrequency Ablation:

> Radiofrequency ablation (RFA) delivers an electrical current to the

tumor

> tissues, which causes them to vibrate rapidly and create frictional

heating.

Hi Deva,

Thank you for posting this article...it is among the best that I have

seen in my five years of researching this disease.

As I type this, I am treating myself to similar technology in my own

home using radio frequencies via a Hulda zapper. No doctors,

no hospitals, no waiting, no invasiveness, and once I purchased the

zapper, no expense.

I can (and do, daily) direct the current from the zapper to

infinitisemally small areas of my body...say, to only the white blood

cells inside the arteries which are inside a tumor which is in the

left breast.

With a zapper there is no heating, and no killing of cells. There is

a temporary superactivation of white blood cells and subsequent

removal of toxins and organisms from the area zapped. The elegance

of this, is that the white blood cells decide what to phagocytize, or

remove.

At the moment, I am directing the 9 volts of dc current at a

frequency of 30,000 Hz, through copper tube electrodes under my feet

to the arteries, veins and capillaries in my left adrenal gland.

This is an amazing technology.

Love,

[Guest guest]

> Is this similar to the rife machine?

Hi Mona,

They are similar, but different.

Both use electrical frequencies...but in a different range.

Both can be self administered at home without a doctor.

Whereas the Rife machine generally uses a variety of frequencies for

different conditions, plate zapping uses a constant frequency but a

variety of tissue and organ samples to target specific locations in

the body.

The inventor of the Rife machine is unfortunately no longer with us

and hasn't been for several decades.

The inventor of the zapper is alive and well and continuously

researching and publishing books with her latest research for cancer,

HIV and other illnesses.

Rife machines may be quite expensive, zappers cost considerably less,

though there is an additional expense for microscopic slides of

organs for using on the plates.

These are just a few things that came to mind.