Cryotherapy as a Surgical De-Escalation Strategy in Breast Cancer: Techniques, Complications, and Oncological...

Background: Early breast cancer outcomes have improved substantially, yet surgery may carry physical and psychosocial costs. Cryotherapy has gained attention as a minimally invasive alternative to surgery for select patients with breast cancer: particularly, those with small, unifocal, hormone receptor-positive tumors. Given rapidly expanding but heterogeneous reports, this state-of-the-art review therefore aims to synthesize information on how breast cryotherapy is performed, for whom it is most suitable, what outcomes to expect, and where evidence is still immature. Methods: We queried MEDLINE (via PubMed), Embase (via Ovid), and the Cochrane Library up to January 2025, using terms related to "breast neoplasms," "cryotherapy," and "cryoablation." Eligible studies included clinical trials, cohort studies, and case series reporting outcomes of cryotherapy in breast cancer. Data were extracted on patient characteristics, procedural parameters, recurrence, survival, and complications. The risk of bias was assessed using the MINORS tool, and certainty of evidence was appraised with the GRADE framework. Results: A total of thirty one studies (comprising 1357 patients) formed the evidence corpus summarized here. Most involved early-stage, hormone receptor-positive breast cancers ≤ 2 cm treated with percutaneous cryoablation. Local recurrence, defined as any ipsilateral breast tumor recurrence confirmed radiologically or histologically, ranged from 0 to 68.8%, with smaller, unifocal tumors achieving the best control. Overall survival exceeded 80% in early-stage disease, while complications were generally minor, including bruising, hematoma, and skin erythema. Patient satisfaction was high, with favorable cosmetic outcomes reported in limited studies. However, the follow-up duration ranged from 1 month to 10 years (with nearly half < 1 year), and protocols varied substantially across studies. In summary, breast cryotherapy appears safe and can achieve encouraging local control and cosmetic results in carefully selected early-stage cases. Its role in aggressive subtypes, larger or multifocal disease, and as part of multimodal regimens requires further study. Conclusions: Standardized protocols, imaging/reporting conventions, and longer follow-up with patient-reported outcomes are needed to advance the field and further define where cryotherapy can appropriately de-escalate surgery.