What happened, in summary

A woman in her 90s developed a new breast mass 4 years after breast-conserving surgery for triple-negative invasive ductal carcinoma. The recurrent tumor involved the breast and 3 level I axillary lymph nodes, with no distant metastases on PET-CT. Capecitabine was started but stopped after 14 days because of severe rash, skin peeling, mouth inflammation, frequent urination, and a fungal infection. She declined additional chemotherapy, surgery, and radiation.

During the next 8 months, the breast disease became multicentric and extended toward the nipple and axillary tail. Additional level II lymph nodes also became involved. She chose palliative cryoablation to reduce the amount of tumor, prevent erosion through the skin or nipple, and control pain.

Four outpatient cryoablation procedures were performed over time under local anesthesia. Each procedure treated a separate active area as the pattern of disease changed. She reported only minor discomfort from the local anesthetic, needed no wound care, and had no procedure-related complication. One treatment was specifically used to relieve nipple pain and reduce the risk of direct nipple invasion.

At the latest follow-up, 29 months after the recurrence was diagnosed and 20 months after the first cryoablation, imaging showed no viable tumor at the treated breast sites. The axillary nodes remained unchanged, and she had no breast or nipple pain. She continued to live independently and remained active in her community.

The goal was local comfort and control rather than cure, and each decision reflected her wish to avoid more aggressive treatment.