Minimally invasive ablative techniques in the treatment of breast cancer: a systematic review and meta-analysis

Abstract

Purpose: Breast-conserving surgery is effective for breast cancer treatment but is associated with morbidity in particular high re-excision rates. We performed a systematic review and meta-analysis to assess the current evidence for clinical outcomes with minimally invasive ablative techniques in the non-surgical treatment of breast cancer.

Methods: A systematic search of the literature was performed using PubMed and Medline library databases to identify all studies published between 1994 and May 2016. Studies were considered eligible for inclusion if they evaluated the role of ablative techniques in the treatment of breast cancer and included ten patients or more. Studies that failed to fulfil the inclusion criteria were excluded.

Results: We identified 63 studies including 1608 patients whose breast tumours were treated with radiofrequency (RFA), high intensity focussed ultrasound (HIFU), cryo-, laser or microwave ablation. Fifty studies reported on the number of patients with complete ablation as found on histopathology and the highest rate of complete ablation was achieved with RFA (87.1%, 491/564) and microwave ablation (83.2%, 89/107). Short-term complications were most often reported with microwave ablation (14.6%, 21/144). Recurrence was reported in 24 patients (4.2%, 24/570) and most often with laser ablation (10.7%, 11/103). The shortest treatment times were observed with RFA (15.6 ± 5.6 min) and the longest with HIFU (101.5 ± 46.6 min).

Conclusion: Minimally invasive ablative techniques are able to successfully induce coagulative necrosis in breast cancer with a low side effect profile. Adequately powered and prospectively conducted cohort trials are required to confirm complete pathological ablation in all patients.

Keywords:

• Ablative techniques
• radiofrequency ablation (RFA)
• laser-ablation
• cryo ablation
• high-intensity focussed ultrasound (HIFU)
• microwave ablation
• breast cancer

Acknowledgements

Authors M. P., M. A., A. N. and M. D. have special interest in the HIFU technique. M. D. has some prior experience with RFA and laser ablation. None of the other ablative techniques mentioned in the manuscript have been used by the authors.

Disclosure statement

The authors report that they have no conflicts of interest.

Funding

The author would like to thank Theraclion Ltd (Malakoff, France) for an unrestricted educational grant.