What happened, in summary

A woman in her 60s was diagnosed with a 42 mm HER2-positive, estrogen receptor-negative invasive ductal carcinoma in the left breast and ductal carcinoma in situ in the right breast. She received epirubicin and cyclophosphamide, followed by weekly paclitaxel with trastuzumab and pertuzumab. This was followed by bilateral lumpectomy, radiation, and 1 year of trastuzumab.

The left-breast cancer later returned and spread to both lungs. Over several years, she received vinorelbine with trastuzumab and pertuzumab, mastectomy, several lung resections, T-DM1, and stereotactic radiation. Eventually, only a single 7 mm metastasis remained close to the surface of the lung. Further surgery was not considered feasible.

She underwent outpatient CT-guided cryoablation. A probe was placed through the chest wall into the small lung lesion, which was frozen under image guidance. The procedure lasted about 40 minutes. She went home 2 hours later and did not require overnight admission. Mild coughing of blood stopped within 2 days.

She did not receive systemic therapy after the ablation. PET-CT at 3, 6, 9, and 12 months showed no growth of the treated area and no new lesions. Her disease therefore remained stable without progression for at least 1 year after the procedure. The result supported local treatment for a carefully selected solitary lung metastasis.

Cryoablation was chosen because the lesion was small, isolated, and close to the pleural surface. It offered local control without another lung operation or an immediate return to systemic therapy. No systemic therapy was given during the 12-month post-ablation surveillance period.