Cancer care continues to be one of the key cost drivers contributing to the $3.5 trillion healthcare costs in the United States, but minimally invasive treatments like Cryoablation Therapy may hold the promise of significantly reducing oncology related costs, while improving patient outcomes. It has the potential of reducing months of recovery time to only a few minutes, and the scope of cryoablation expands exponentially especially when utilized in concert with personalized precision medicine.
Cryoablation, also called cryosurgery, utilizes extreme cold temperatures produced by cooling agents, such as, liquid nitrogen to kill cancer cells and abnormal tissues. During cryoablation, a thin, wand-like hollow needle, known as the cryoprobe, is inserted through the skin, directly into the cancerous tumors.
Through this minimally invasive procedure, a cooling gas is pumped into the cryoprobe to freeze the malignant or abnormal cells, which are then allowed to thaw for some time. The freezing and thawing process is repeated multiple times during the same treatment session to necrose the tumor. This image guided procedure can be performed within 20 to 30 minutes, and it typically does not require hospital stays nor does it leave any scars, and patients walk out of their treatment facilities with just a band-aid at the site of needle insertion.
Cryoablation therapy’s quick recovery time, optimistic health outcomes, as well as its positive cosmetic value makes it a favorable treatment option for not only breast cancer and skin cancer patients, but for other patients with certain solid tumors as well. The advancements in image-guided technology have further enhanced the scope of cryoablation therapy as interventional radiologists performing the procedure have better control over the treatment. They can actually see the tumor freeze in real time, leaving clear margins, as the cooling agent is precisely deployed at the core of the tumor.
Scientific literature indicates that the controlled destruction of tissue by freezing, which is widely practiced in medicine today, has been appreciated for many thousands of years. Dr. James Arnott, an English physician, was the first to describe the achievements of improved results via the application of low temperatures in the treatment of women with breast cancer in 1850. He used iced saline solutions on women with locally advanced breast tumors. That was the beginning of cryotherapy ablation, and this procedure has come a long way since then, with the latest clinical trials establishing it as a safe and well- tolerated office-based procedure for the ablation of early-stage breast cancer.
However, with the advancements in personalized precision oncology, cryoablation therapy can be successfully utilized for late-stage breast cancer treatment as well, though it is not the first or only treatment. Initially, attempts are made to shrink the tumor size by utilizing personalized medicine and immunotherapies. If the tumor shrinks down to an appropriate size and is at a suitable location, then cryoablation treatments can be utilized as one of the tools even in late-stage breast cancers, thus avoiding the need for maximum therapeutic dose untargeted chemotherapy and radiation.
Depending on factors like tumor size, its location, type of breast cancer, and its genetic targets, cryoablation therapy, when used in combination with personalized medicine, may eliminate the need for invasive surgeries like mastectomies and lumpectomies. These invasive surgeries are aimed at removing the cancerous cells while cryoablation therapies are designed to kill the cancerous cells and deactivate the tumor.
Deactivating the tumor leaves scope for utilizing the antigen information released by the dead tumor, which can potentially train the immune system to identify and kill cancer cells elsewhere in the body. Recent medical research indicates that cryoablation, in addition to causing tumor tissue necrosis and apoptosis, can facilitate the release of tumor-derived autoantigens in the bloodstream and activate the host immune system to elicit beneficial anti-tumor immunological responses against the primary tumor. This may result in regression of the primary tumor and distant metastasis.
Harnessing the power of the immune system through advanced personalized and precision medicine can play a critical role in reducing the chances of a potential recurrence or metastasis. The ability to minimize chances of recurrence can be a gamechanger in cancer treatment, especially breast cancers, as studies highlight that almost 30% of patients with breast cancer who are free of disease after initial local and regional treatments present with disease recurrence during follow-up.
The personalized precision medicine approach is based on detailed genomic analysis of each patient’s individual disease, while assessing other factors like infectious, environmental toxins, heavy metals, and chemical toxicities, which could be responsible for driving the mutations causing the disease. Detailed investigation of all these factors helps physicians, trained in personalized precision oncology approach, to derive crucial information about each individual tumor and ascertain whether there are signs of early micro metastasis. Deciphering this information is critical for determining the future course of treatment, as lack of knowledge about the early signs of micro metastasis may lead to suboptimal outcomes in the future.
Unfortunately, the personalized precision medicine approach is not typically followed in standard oncology care, which is why early signs of micro metastasis may get missed in certain patients leading to recurrence or metastatic spread of disease. Personalized precision medicine plays a key role in capturing this information about early signs of micro metastasis, and in case of its presence, utilizing the immunological benefits of cryoablation therapy can significantly potentiate responses in cancer patients.
The cold temperatures utilized in cryoablation therapy not only enhances pain management due to its anesthetic effects, but it also makes cryoablation a favorable tool for utilizing advanced immunotherapy options in patients. Other ablative techniques like Radiofrequency ablation (RFA) and Microwave ablation (MWA) utilize extreme heat to ablate tumors, and excessive heat is not ideal for capturing the antigen information released by the necrosed tumor, which is crucial for eliciting the desired immunological response.
Similarly, surgeries also do not leave the scope of capturing tumor antigen information as the tumors are surgically removed. Destruction of the antigen information weakens the immune system, limiting its ability in strengthening the body to sustain lasting outcomes. The decision of whether to opt for surgical removal of the tumor or its cryoablation depends on the size of the lesion, its location, and also on the comfort level of the physician, to a certain extent.
According to the National Cancer Institute (NCI), cryosurgery has the following benefits:
- For tumors inside the body, only a small cut or puncture is usually needed to insert the cryoprobe through the skin. As a result, pain, bleeding, and other problems that come with surgery are reduced.
- Cryosurgery can often be done with local anesthesia and may not require a hospital stay.
- Since cryosurgery is a local treatment and doctors can focus treatment on a precise area, damage to nearby healthy tissue can be reduced.
- Cryosurgery can be repeated safely and may be used with other cancer treatments.
- Cryosurgery may be used when tumors can’t be removed with surgery or when people can’t have surgery because of their age or other medical problems.
- Cryosurgery may be an option when the cancer does not respond to standard treatments.
Despite the myriad of benefits, cryoablation is still not as widely utilized in standard cancer care facilities because of lack of insurance coverage for it. Unfortunately, insurance companies are not incentivized for patient outcomes, rather their business model thrives on a complicated network of billable services and negotiated rates with hospitals and specialty care clinics. Such complicated arrangements are one of the reasons why lumpectomy, which is a high billable service followed by chemotherapy and radiation, are typically recommended for breast cancer care.
Due to these complexities of the medical industrial complex, which includes several players, such as the insurance companies, big pharmaceutical companies, and hospitals, there continues to be an industry bias against cryoablation. Only a handful of early-stage breast cancer patients, skin cancer patients, and patients with certain other types of cancers may get insurance coverage for cryoablation therapies.
Such revolutionary minimally invasive procedures threaten to positively disrupt the medical industrial complex, especially when used in combination with personalized precision medicine. Ironically, even precision medicine is not covered as the first line of treatment in cancer care because implementing this level of precise targeting of cancer cells requires much more detailed diagnostics and lab work. The mammoth infrastructure of the US healthcare system is slow to adapt to these changes which explains why precision medicine is still not considered mainstream conventional cancer care.
However, I am hopeful that in the future precision medicine will be covered by insurance as doing so will not only make cryoablation therapy an even more powerful arsenal for the treatment of cancer, but it will also open the doors to many more treatment options for patients with varied types and stages of cancer.
Editor’s Note: Dr. John Oertle is a leading expert in advanced precision medicine. He is the Chief Medical Director at Envita Medical Centers, specializing in individualized outcome-based care models for chronic disease and integrative oncology. He is well-published in the areas of cancer genomics, immunotherapy, and chronic Lyme disease. Dr. Oertle graduated with honors from Arizona State University with his Bachelors of Science in Psychology, and graduated with honors from Southwest College of Naturopathic Medicine as a Naturopathic Medical Doctor. He earned a Certificate with Distinction in medical bioethics from the National Catholic Bioethics Center. He is a member of Envita’s Molecular Tumor Board and actively participates in publishing research papers and treatment development. He is the Director of Residents at Envita through the partnership with National University of Natural Medicine. He also is a member of the Unipathic Medical Board, ensuring the highest standards of integrative medicine.