CANCER IS OFTEN TREATED with surgery to remove the tumor followed by radiation therapy to kill any remaining cancer cells. But some patients may find their doctor recommends cryoablation, a less invasive procedure that uses extreme cold to kill cancer cells, as an alternative to surgery or radiation.
Imaging technologies developed in the 1980s and 1990s created the opportunity to use cryoablation to treat cancer. It is typically used to treat small tumors that can’t be removed surgically. It also can be used instead of radiation to treat pain caused by metastases that have spread to bones or other organs. Medicare and Medicaid first covered its use as a prostate cancer treatment in 1999. It is now also used to treat some small tumors in the eye, kidney, liver, lung and skin. Insurance coverage varies based on cancer type and insurer.
Questions for Your Doctor
To find out if cryoablation is one of your treatment options, you can ask your health care team:
- Has cryoablation been studied in my type of cancer?
- What did the studies show?
- Do you use this type of treatment?
- If my cancer spreads, would you use cryoablation to treat cancer-related pain?
- Should I consider a clinical trial using cryoablation alone or with other treatments?
Cryoablation is usually performed by a surgeon or an interventional radiologist, a doctor who specializes in procedures that require imaging technology. It’s usually an outpatient procedure, but if “a patient is having pain or other issues, we would watch them overnight and then send them home the next day,” says Ed Boas, an interventional radiologist at Memorial Sloan Kettering Cancer Center in New York City.
During the procedure, the doctor uses imaging technology to guide one or more thin, hollow needles through the skin and into the primary tumor or the metastasis. Liquid nitrogen or a similar gas is inserted through the needle to kill the cancer cells. The tumor shrinks over time as the cells thaw and the body absorbs the dead tissue.
Patients with early-stage cancer who are treated with cryoablation will usually have an imaging scan one month later to see if the tumor is gone. They will then have scans every few months to make sure the tumor is not growing back. If there is a limited recurrence, says Boas, it may be possible to use cryotherapy again. If it has spread, “the patient may need chemotherapy.”
Cryoablation typically results in less pain and bleeding than surgery, and patients typically recover faster. However, nearby tissue and nerves can be affected by the cold temperature, causing side effects like loss of sensation, skin injury, pain and swelling.
Clinical trials are investigating the effectiveness of cryoablation when it is used alone or with other treatments. One trial that began in 2017 is enrolling 50 patients with esophageal cancer that cannot be treated surgically; all patients will receive cryoablation and chemotherapy. The aim of this study is to see if cryoablation reduces the tumor’s size and helps improve quality of life. Another study, started in 2019, is enrolling 15 patients with metastatic melanoma, all of whom will receive an immunotherapy drug injected into the tumor followed by cryoablation. This study will evaluate whether cryoablation makes the immunotherapy more effective.
A breast cancer clinical trial expected to start later this year will treat 20 patients with small breast tumors with cryoablation. Another trial, started in 2019, will treat 160 patients with triple-negative breast cancer with either immunotherapy and cryoablation followed by surgery, or surgery alone.
Patients with triple-negative breast cancer are often young and have a high risk of recurrence, says Heather McArthur, a breast medical oncologist at Cedars-Sinai Medical Center in Los Angeles. “It’s an area of unmet need, and it’s critically important that we identify innovative strategies for that population,” McArthur says.
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March 24, 2020