Breast Cancer

Background

Clinical KeyBreast cancer is the most common cancer in women. A study by the University of Washington estimates that more than 1.6 million new cases of breast cancer occurred among women worldwide in 2010. In the United States, according to the National Cancer Institute, breast cancer was expected to account for more than 232,000 new cases in women, more than 2,000 new cases in men, and more than 40,000 deaths in 2013. The risk for breast cancer increases with age.

Current Treatment

Common treatment options for breast cancer include surgery, radiation, chemotherapy, hormone therapy, and biologically targeted pharmacologic therapies. Typical treatment regimens can involve combinations of several options. However, the precise treatment regimen depends on the location, type, hormonal status and stage of the cancer, as well as decisions by the patient and care team.  For small tumors confined to the breast (which are not behind the nipple), the standard of care is lumpectomy and radiation.

Surgery
Surgery involves either lumpectomy or mastectomy, both of which aim to eradicate the tumor and reduce the risk for recurrence. Lumpectomy involves the removal of the tumor surrounded by a rim of normal breast tissue, whereas mastectomy involves removal of the entire breast. Surgery usually includes the removal or at least sampling of lymph nodes in the arm pit.

Radiation
Radiation of the breast and axilla (armpit) is used as an adjuvant to surgical removal of the lump, and is intended to kill cancer cells that might have been left behind. This can be done externally by using a radiotherapy machine to send high energy beams toward the tumor, or it can be done internally by using a needle, seed, or tube to place radioactive material directly into the area of the cancer and the cancer bed.

Chemotherapy
Chemotherapy involves the use of drugs that kill cells or stop them from dividing. The type of chemotherapeutic agents used depends on the type and stage of the tumor. Chemotherapy can be used alone or following surgery.

Hormone Therapies
Hormone therapies, also called endocrine therapies, are used for patients whose tumors respond to hormones. These therapies block the production of hormones, prevent hormones from interacting with their receptors, or directly target the receptors themselves.

Targeted Therapies
Targeted therapies interfere with signals required by breast tumors to survive and grow. These therapies are prescribed for patients whose tumors show abnormal production of signaling molecules such as HER2/neu.

Focused Ultrasound Treatment

Focused ultrasound offers a potentially non-invasive alternative to surgical lumpectomy. Rather than creating an incision to remove the tumor, the physician uses magnetic resonance imaging (MRI) or ultrasound guidance to identify the tumor and to direct a focused beam of acoustic energy through the skin into the tumor. This beam heats and destroys the tumor without damaging nearby structures or tissues. A follow-up MRI can determine whether the entire tumor has been ablated/ destroyed, and if necessary, focused ultrasound can be repeated. 

As a non-invasive method of lumpectomy, focused ultrasound may offer the following benefits in treating breast cancer:

  • fewer complications and a short recovery time, compared with surgical lumpectomy;
  • no scar tissue and reduced risk for breast deformation;
  • reduced risk for infection; and
  • more precise treatment as a result of real-time guidance by magnetic resonance or ultrasound.

With increased precision, focused ultrasound has the potential to be a more effective lumpectomy than surgery. Thus it could potentially be a primary treatment approach for some patients.

Because there is no surgical removal of tissue involved, however, there are some potential drawbacks to focused ultrasound treatment:

  • It does not allow for laboratory verification of complete removal of the tumor.
  • It does not produce samples to enable analysis of the tumor for planning adjuvant therapy.

There is also potential for damage to non-targeted tissue, such as the skin.

Regulatory Approval and Reimbursement

The Model JC Focused Tumor Treatment System, which is manufactured by Chongqing Haifu Technology, has been approved in Europe for the treatment of breast cancer.

The use of focused ultrasound to treat breast cancer is not yet a procedure universally reimbursed by medical insurance providers.

Treatment Sites

While treatment is not approved in the United States, there are many sites worldwide that offer this treatment.

Please see here for a list

Clinical Trials

See here for a list of clinical trials for breast cancer using focused ultrasound

Notable Papers

Merckel LG, Knuttel FM, Deckers R, van Dalen T, Schubert G, Peters NH, Weits T, van Diest PJ, Mali WP, Vaessen PH, van Gorp JM, Moonen CT, Bartels LW, van den Bosch MA. First clinical experience with a dedicated MRI-guided high-intensity focused ultrasound system for breast cancer ablation. Eur Radiol. 2016 Feb 6.

Alkins R, Burgess A, Kerbel R, Wels WS, Hynynen K. Early treatment of HER2-amplified brain tumors with targeted NK-92 cells and focused ultrasound improves survival. Neuro Oncol. 2016 Jan 26. pii: nov318.

Peek MC, Ahmed M, Pinder SE, Douek M. A review of ablative techniques in the treatment of breast fibroadenomata. J Ther Ultrasound. 2016 Jan 19;4:1. doi: 10.1186/s40349-016-0045-z. eCollection 2016.

Knuttel FM, Waaijer L, Merckel LG, van den Bosch MA, Witkamp AJ, Deckers R, van Diest PJ. Histopathology of breast cancer after magnetic resonance-guided high intensity focused ultrasound and radiofrequency ablation. Histopathology. 2016 Jan 5. doi: 10.1111/his.12926.

Hsiao YH, Kuo SJ, Tsai HD, Chou MC, Yeh GP. Clinical Application of High-intensity Focused Ultrasound in Cancer Therapy. J Cancer. 2016 Jan 3;7(3):225-31. doi: 10.7150/jca.13906. eCollection 2016.

Li S, Wu PH. Comparison of magnetic resonance- and ultrasound-guided high-intensity focused ultrasound in the treatment of breast cancer. Chin J Cancer. 2013 Aug;32(8):441-52. Epub2012 Dec 14.

Merckel LG, Bartels LW, Köhler MO, van den Bongard HJ, Deckers R, Mali WP, Binkert CA, Moonen CT, Gilhuijs KG, van den Bosch MA. MR-guided high-intensity focused ultrasound ablation of breast cancer with a dedicated breast platform. Cardiovasc Intervent Radiol.2013 Apr;36(2):292-301. Epub2012 Dec 12.

Furusawa H, Namba K, Nakahara H, Tanaka C, Yasuda Y, Hirabara E, Imahariyama M, Komaki K. The evolving non-surgical ablation of breast cancer: MR guided focused ultrasound (MRgFUS). Breast Cancer 2007;14(1):55-8.

Wu F, Wang ZB, Cao YD, Zhu XQ, Zhu H, Chen WZ, Zou JZ. “Wide local ablation” of localized breast cancer using high intensity focused ultrasound. J Surg Oncol 2007 Aug 1;96(2):130-6.

Click here for additional references from PubMed.

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