Tolerability of breast radiotherapy following cryoablation in the local management or palliation of breast cancer: a case series

Introduction: Breast cancer is the most common malignancy among women worldwide, with surgery and radiotherapy constituting the typical standard of care. For patients who are poor surgical candidates, cryoablation offers a minimally invasive alternative with several advantages: preservation of normal tissue architecture, favorable cosmetic outcomes, and the ability to perform the procedure under local anesthesia. However, the feasibility and safety of delivering radiotherapy following cryoablation remain largely unexplored. Methods: In this retrospective single-institution case series, we report outcomes in nine women with non-operative management of breast carcinoma who underwent cryoablation followed by radiotherapy between 2018 and 2023. Tumor characteristics, reasons for inoperability, treatment parameters, and toxicity data were extracted from the electronic medical record. The primary objective was to assess the tolerability and toxicity profile of radiotherapy administered after cryoablation. Results: All nine patients completed radiotherapy without treatment breaks or dose reductions. The median tumor size was 2.3 cm (range: 0.6–4.8 cm). At a median follow-up of 30.6 months, no patient experienced skin necrosis, significant pain, or fibrosis attributable to the combined treatment. One patient developed grade 2 lymphedema; no other grade 2 or higher toxicities were observed. Although disease progression occurred in some patients due to non-definitive local intent, treatment-related toxicity remained minimal throughout the observation period. Conclusion: This case series demonstrates that radiotherapy following cryoablation is feasible, safe, and well-tolerated in patients with inoperable breast cancer, with no significant procedural complications or treatment-related toxicity. These preliminary findings support further investigation of cryoablation followed by radiotherapy as a viable treatment option for patients lacking curative surgical pathways.