CLINICAL STUDY Breast Cryoablation in Patients with Bone Metastatic Breast Cancer Claudio Pusceddu, MD, Barbara Sotgia, MD, Giovanni Amucano, MD, Rosa Maria Fele, MD, Sara Pilleri, MD, Giovanni Battista Meloni, MD, and Luca Melis, MD ABSTRACT Purpose: To assess retrospectively the safety and feasibility of palliative breast cryoablation to treat primary breast tumors in patients with stage IV breast cancer. Materials and Methods: In 17 female patients (mean age  SD, 59 y  13; range, 37–81 y) with 22 bone metastatic ductal invasive breast lesions (2.5 cm  1.6 cm  1.4  1.1; range, 1.0 cm  0.5 cm to 6.7 cm  5.5 cm), 19 computed tomography (CT)–guided percutaneous cryoablation sessions were performed for treatment of primary breast tumors. All patients had radiologic evidence (contrast-enhanced CT or magnetic resonance imaging) of persistence or progression of the primary breast cancer despite systemic therapy. The radiologic outcome was evaluated with a mean follow-up period of 13 months (range, 3–31 mo). Treatment of skeletal metastases was unnecessary during the follow-up period. Results: All of the cryoablation sessions were completed and well tolerated. Complete regression of the disease was achieved in 15 (88%) patients 2 months after the cryoablation. Two (12%) patients underwent a second cryoablation treatment because of a minimal persistence of viable tumor (residual disease). No relapse of primary tumors was observed on breast imaging during the follow-up period. One patient (6%) developed a new lesion localized to the contralateral breast. Conclusions: These data suggest that palliative cryoablation of primary advanced breast cancer is a well-tolerated, feasible, and effective treatment option. Given the palliative effects of breast cryoablation demonstrated in this series, larger studies replicating these results are warranted. ABBREVIATIONS HU = Hounsfield unit, ROI = region of interest Metastatic breast cancer at diagnosis represents approx- imately 6%–10% of all new breast cancers. The prog- nosis for this group of patients is generally unfavorable. The 5-year relative survival rate is only 23%, although the overall survival is improving with the risk of death decreasing by 1%–2% each year (1,2). Metastatic breast cancer is considered an incurable disease, and the main treatment goal is palliation, with the aim of maintaining or improving the quality of life and possibly improving survival. Palliative treatment options currently available to these patients include external-beam radiotherapy, chemotherapy and combined modalities, endocrine therapies, and biologic agents (1–3). Traditionally, the local treatment of stage IV breast cancer, through either surgery or radiotherapy, has been reserved for palliation of advanced local disease to prevent local complications (4,5). Population and institutional database reviews suggest that a significant percentage of women (approx- imately 40%–60%) receive surgery for their primary breast tumor as a component of therapy for stage IV disease (6–8). The biologic rationale for removing the primary breast tumor in cases of proven disease dissemination is debatable, but several observational studies have exhibited a higher survival rate among patients with stage IV breast cancer in whom the primary tumor is completely excised at the time of diagnosis (9–12). Ablative techniques, such as radiofrequency ablation, & SIR, 2014 J Vasc Interv Radiol 2014; XX:]]]–]]] http://dx.doi.org/10.1016/j.jvir.2014.05.001 None of the authors have identified a conflict of interest. From the Division of Interventional Radiology (C.P.), Department of Oncolo- gical Radiology (B.S., G.A., R.M.F., L.M.), Ocological Hospital “A. Businco,” Regional Referral Center for Oncologic Diseases, Cagliari 09100, Italy; and Complex Operative Unit of Radiology (S.P., G.B.M.), Institute of Radiological Sciences, University of Sassari, Sassari, Italy. Received September 10, 2013; final revision received April 29, 2014; accepted May 2, 2014. Address correspondence to C.P.; E-mail: clapusceddu@gmail.com