For Chanderkala Lohani, now 78, each battle has been tougher than the last. Having lost her husband at a young age, she raised three daughters and a son on her own. At age 64, she got detected with the most aggressive kind of breast cancer and a genetic heart condition that she never knew existed, ruling out half the standard treatments. She needed surgery but had to manage with local anaesthesia and sedation as general anaesthesia could stress her compromised heart. The cancer came back last year and this time she braved a novel therapy. But in the end, she demonstrated that cancer can be fought at any age. With a little help from technology.
Lohani was diagnosed with triple-negative breast cancer which manifested as a small lump in the upper side of her left breast. “It is a type of breast cancer that does not have three common receptors found in most breast cancers: estrogen, progesterone, and HER2. These receptors usually help doctors choose targeted treatments, so when they are absent, hormone therapies and HER2-targeted drugs do not work. Surgery under general anaesthesia was out of the question as she had hypertrophic cardiomyopathy, which had thickened her heart muscles, making it difficult for the heart to pump blood. We did not want to risk a sudden death during a procedure. Chemotherapy and radiotherapy were out of question because they were cardiotoxic,” says Dr Ramesh Sarin, surgical oncologist, Apollo Hospital, Delhi.
As triple negative breast cancer spreads fast, Dr Sarin proceeded to control it locally with surgery, done with local anaesthesia and sedation. “Luckily, we were able to remove all of it,” says Dr Sarin. But since this type of cancer keeps returning, Lohani was no exception. “Late last year, it was detected during a routine follow-up screening, something she was disciplined about. But the problems were the same. She still was high risk and in such cases doctors do a comparative analysis of whether the co-morbidities or the cancer can complicate matters on the table,” she adds.
Chanderkala Lohani with her children (Express photo)
But this time, she had the third option called cryoablation, a minimally invasive treatment that destroys a breast tumour by freezing it, instead of removing it through surgery. “It’s approved by the US FDA (Food and Drug Administration), safe, has a quick recovery and the patient can go home the same day, reducing hospital stay. Most important, it is an option for those who cannot afford conventional surgery and are aged. I am planning to use it for a 95-year-old patient of mine, too,” says Dr Sarin.
What is cryoablation for breast cancer?
Surgery continues to be the standard first line of treatment for breast cancer. However, in carefully selected patients, such as those who are medically unfit for surgery or who choose not to undergo it, cryoablation is an option.
In this procedure, a thin needle-like probe is inserted into the tumour, usually under ultrasound or CT guidance. “Extremely cold temperatures are then applied there, forming an ice ball around the cancer cells. This freezing damages and kills the cells. The body then removes the destroyed tissue over time,” says Dr Sarin.
Cryoablation is usually done under local anaesthesia, something that suited Lohani, and is often completed in less than an hour. “Because there is no large incision, recovery is quicker, pain is minimal and there is little scarring. Patients can go home in a few hours if there are no complications,” says Dr Sarin. Scans have shown that her tumour has been destroyed completely.
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Who qualifies for cryoablation?
This is not a one-size-fits-all formula. “Cryoablation is suitable for early-stage breast cancers (T1 or T2 tumours measuring less than 5 cm) that have not spread to the lymph nodes or elsewhere in the body. The tumour should also have well-defined margins, so that it can be frozen completely,”
At present, cryoablation is mainly used for small, early-stage breast cancers for patients who cannot undergo surgery due to age or other medical conditions. It is not yet a standard replacement for surgery as long-term outcomes are still being studied.
What about success rates?
Major trials show very high success in completely destroying small breast cancers, especially those ≤1 cm, with some studies reporting almost 100% complete ablation for tiny tumours. For tumours up to about 2 cm, success rates in clinical settings have been reported in the 90 %+ range. In the large ICE3 clinical trial of early-stage, low-risk breast cancers treated with cryoablation plus hormone therapy, about 96–97 % of patients were free of local recurrence at 5 years. This is similar to outcomes seen with lumpectomy in similar patient groups.
What about costs?
This is almost twice the cost of regular breast cancer surgery and ranges between Rs 2 to 6 lakh, of course eliminating added costs for other supportive therapies. This is not covered by insurance due to its status as a newer, less-conventional treatment. It can be covered if deemed medically necessary and pre-authorised. Of course, it is to be used in very specific cases.
Chanderkala Lohani with her children (Express photo)
