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| |  DG DISPATCH - RSNA: Breast Cancer “Cure” Without Surgery By W. A. Thomasson, PhD Special to DG News
CHICAGO, IL -- November 28, 2000 -- Focused ultrasound under magnetic resonance imaging (MRI) guidance can completely ablate many breast cancers, according to a new study. David Gianfelice, MD, of St. Luc Hospital, Montreal, Canada, presented these findings at the annual meeting of the Radiological Society of North America, in Chicago, Illinois. The procedure utilizes a focused ultrasound transducer built into a standard MRI apparatus. The patient lies prone on the table with the breast to be treated immersed in a water bath that houses the ultrasound apparatus. MRI is used both to guide the ultrasound apparatus and to assess the extent of the area affected by heating. The amount of tissue affected per impulse depends both on power and on time. At 100 W of power, a 12-sec pulse will destroy a volume of tissue about 4 mm in diameter. The treatment takes about 78 minutes (which may be reduced with newer equipment now available) and total time on the table is about two hours. Treatment is done on an outpatient basis under mild conscious sedation. In addition to standard radiological follow-up, including scans for appearance of metastases, the tumor area is biopsied at six months. Any patients found to have residual tumor are then retreated. Twenty-two patients have been treated with this technique to date. Sixteen of these were considered poor surgical candidates, mainly due to advanced age, while six had refused surgery. The tumors ranged in size from 6 mm to 25 mm. Thirteen patients were found to be tumor-free on the initial follow-up biopsy and four more were cancer-free when examined following the second treatment. One is still awaiting her second treatment, and four were considered failures after the second treatment. The only complication has been a mild skin burn during treatment of a quite superficial carcinoma. Focused ultrasound is an extremely attractive option for treatment of localized breast cancer in patients who are poor surgical candidates, the researchers concluded. Whether it can be considered for selected cancers, even in patients for whom surgery is an option, remains to be investigated.
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