eRFA: Excision followed by RFA - A new technique to improve local control in breast cancer

Vicki Klimberg, Julie Kepple, Gal Shafirstein, Laura Adkins, Ronda Henry-Tillman, Emad Youssef, Jorge Brito, Lori Talley, Soheila Korourian

Research output: Contribution to journalArticle

36 Scopus citations

Abstract

Introduction: Excision followed by RFA (eRFA) may allow improved cosmesis while ensuring negative margins in patients with breast cancer. This technique utilizes heat to create an additional tumor-free zone around the lumpectomy cavity. We hypothesized that eRFA will decrease the need for re-excision of inadequate margins. Methods: Between July 2002 and January 2005, we conducted a multiphase trial of RFA of prophylactic mastectomy specimens and of women desiring lumpectomy. In both models, a lumpectomy was performed, the RFA probe was deployed 1 cm circumferentially into the walls of the lumpectomy cavity and maintained at 100°C for 15 min. Whole mount slides were used to measure the zone of ablation for ex vivo specimens. Hematoxylin and eosin staining of in vivo lumpectomy margins <3 mm was considered inadequate. Results: Nineteen prophylactic mastectomy ablations revealed a consistent perimeter of ablation. Forty-one patients (mean age 63 ± 14 years) had an average tumor size of 1.6 ± 1.5 cm underwent in vivo eRFA, and 25% had inadequate margins: one focally positive, one <2 mm, eight <1 mm and one grossly positive. Only the grossly positive margin was re-excised. Overall complication rate of in vivo ablations was 7.5%. Twenty-four of 41 patients did not have post-eRFA XRT. No in-site local recurrences have occurred during a median follow-up of 24 months (12-45 months). Two patients have occurred elsewhere. Conclusions: The ex vivo ablation model reliably created a 5-10 mm perimeter of ablation. In vivo, this zone reduced the need for re-excision for inadequate margins by 91% (10/11). Short-term follow-up suggests that eRFA could reduce re-excision surgery and local recurrence.

Original languageEnglish (US)
Pages (from-to)1422-1433
Number of pages12
JournalAnnals of Surgical Oncology
Volume13
Issue number11
DOIs
StatePublished - Nov 2006
Externally publishedYes

Keywords

  • Breast cancer
  • eRFA
  • Lumpectomy

ASJC Scopus subject areas

  • Surgery
  • Oncology

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    Klimberg, V., Kepple, J., Shafirstein, G., Adkins, L., Henry-Tillman, R., Youssef, E., Brito, J., Talley, L., & Korourian, S. (2006). eRFA: Excision followed by RFA - A new technique to improve local control in breast cancer. Annals of Surgical Oncology, 13(11), 1422-1433. https://doi.org/10.1245/s10434-006-9151-4