An investigational technique uses radio waves to
treat early breast cancer
When Judy Burke, 51, was offered the chance to participate in a clinical trial that might one
day lead to less invasive breast cancer surgery, she didn't hesitate to volunteer. "That's how doctors
learn," she says matter-of-factly.
Burke was the first patient at UC Davis
Cancer Center to volunteer for a study that is evaluating what may be the next breakthrough in breast
cancer surgery radiofrequency ablation. Sometimes referred to as "nonsurgical lumpectomy,"
the procedure uses radio wave energy, delivered via a small wand inserted into a tumor, to literally cook
cancer cells to death. The procedure offers two potential advantages over current surgical options: A
better cosmetic outcome and less destruction of normal breast tissue, allowing for an easier surgical
"One potential benefit would be a small incision," says Vijay Khatri, the cancer surgeon pioneering
the technique at UC Davis Cancer Center.
"And you would have to kill only the tumor and a very thin layer of tissue surrounding it. In a lumpectomy,
you take out much more tissue. There is also the potential for significantly better cosmetic results."
Thanks to early detection by mammography, breast cancer is increasingly diagnosed when tumors are very
small. These cranberry-sized and smaller lumps tend to be good candidates for tissue-conserving surgery
and are also the ones being considered for radiofrequency ablation.
In the operating room, Khatri locates the tumor either by feel or ultrasound. A small incision is made
in the skin, just large enough to insert the thin probe. When activated, tiny wires at the probe's tip
vibrate rapidly, generating heat by friction. The heat kills all the cells the probe touches, as the surgeon
monitors the procedure's progress on an ultrasound screen.
As part of his study, Khatri then removes the burned tumor surgically, sending the tissue to the lab
for confirmation that all cancer cells have been killed. So far, results are promising.
After completing the initial study, Khatri and his co-investigator, John McGahan, hope to launch a larger
clinical trial that will compare radiofrequency ablation with standard surgical treatments. Patients who
volunteer for the study will be randomly selected to undergo either standard surgery or the new procedure.
Both groups will be followed over many years, allowing researchers to compare recurrence rates.
Khatri hopes the research will pave the way for nonsurgical lumpectomy to become a stanard surgical option
for women with small breast tumors.
For many years, total breast removal was the only choice for women diagnosed with breast cancer. Surgeons
thought that taking out as much of the tissue surrounding a tumor as possible gave patients the best chance
for a cure.
But breast cancer surgery has become kinder and less invasive over the years without any sacrifice
in survival thanks to women like Burke, who were willing to take a chance on promising new techniques.
The radical mastectomy gave way to the simple mastectomy and lumpectomy, as surgeons demonstrated that
less tissue could be removed with equivalent results, especially when surgery is combined with radiation,
chemotherapy or both. Today most of the more than 200,000 women diagnosed with breast cancer each year
undergo lumpectomy, in which just the tumor and a thin margin of surrounding tissue are removed.
Radiofrequency ablation is the latest technique in this trend. But while the approach is new in breast
cancer, surgeons have used it to destroy liver tumors for more than a decade. McGahan was one of the first
physicians in the country to use radiofrequency ablation in liver disease. The technique is also finding
a place in bone cancer treatment, and is being investigated as a therapy for lung and prostate cancers.
As a patient in Khatri's study, Burke underwent a lumpectomy following the radiofrequency ablation procedure.
The resulting disfigurement is mild compared to what breast cancer patients experienced in previous generations.
Still, Burke feels some selfconsciousness. To avoid questions and curious stares, she turns her back when
she slips in or out of her bathing suit in the swimming pool locker room.
All in all, though, she counts herself lucky. Because of women who took part in clinical trials before
her, most of her breast is intact today. And she had an opportunity to play a role in current research
that may allow the next generation of breast cancer patients to emerge from their treatment with only
a tiny scar.