Harries, Simon Anthony; (1995) Interstitial laser photocoagulation as a treatment for breast cancer. Doctoral thesis (Ph.D.), University College London (United Kingdom).

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Abstract

Conservative surgery is a safe alternative to mastectomy for some patients with breast cancer. A survey of surgeons in this thesis has shown that more surgeons would now undertake conservative surgery than they have done in the past. Recently a new technique, interstitial laser photocoagulation(ILP) has been described which is capable of in situ tissue necrosis with safe healing. The idea of ILP takes the concept of conservative surgery for breast cancer a step further. The main purpose of this thesis was to investigate the potential value of ILP as a future method of destroying breast cancers in situ leaving the area to heal via resorption and fibrosis. The aims of this thesis were to study the biology of laser interactions with breast cancers scheduled for surgery(and not to completely destroy the tumour), to optimise the laser parameters of power and exposure for a particular tumour and to find an imaging technique which will accurately predict the extent of laser damage. Forty five patients were treated with ILP prior to surgery(median 7 days). Tumour necrosis varied from 2-25mm. No laser damage was noted in 4 patients. Two patients developed minor complications and treatment was abandoned early due to pain in a further 4 patients. The presence of charring within the tumour was associated with larger diameters of necrosis than when charring was absent(median 13 vs 6 mm, p=0.002) and use of a precharred fibre produced similar lesions(median 14mm) which were more predictable.The histological features in the tumour following ILP were of coagulative necrosis which appeared to heal by the formation of fibrous tissue. An area of heat fixed, morphologically preserved tissue was noted within the zone of coagulative necrosis which was thought to be non-viable. Ultrasonography, Com puterised Tomography(CT) and M agnetic Resonace Imaging(MRI) were all used to monitor necrosis. Ultrasound was unable to predict the extent of necrosis as measured in the resected specimen(r=0.3, p=N.S.) but was reasonable at predicting tumour size(r=0.6, p=0.001). CT and MRI show some promise but were only investigated in small numbers of patients. This study has shown that ILP is simple and safe and when using a pre-charred fibre, predictable. If the initial results of imaging using CT and MRI are confirmed in larger studies then ILP could possibly have a role in the treatment of small breast cancers.

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