The UCSD Moores Cancer Center is the only facility in the state of California to offer women a new device designed to reduce the treatment time and potential side effects from radiation treatment following the removal of cancerous lumps from the breast.
The SAVI applicator, created by BioLucent Inc., allows for customized dosage of accelerated partial breast irradiation (APBI). The ability to target radiation - avoiding damage to healthy tissue such as the skin or chest wall - and a less invasive entry process, help make the treatment accessible to many more women.
“Partial breast radiation, in and of itself, allows more women access to the recommended radiation treatment than ever before,” said Catheryn Yashar, M.D. assistant professor and chief of breast and gynecological services at the UCSD Department of Radiation Oncology.
Since becoming FDA-approved in October of 2006, the SAVI device was introduced into use first at Arizona Oncology Services, then at UCSD. Yashar has treated seven women with early-stage breast cancer since March. While it is not a new type of treatment, the SAVI method offers many benefits to patients.
In a mastectomy, the entire breast is surgically removed. Described as breast conservation therapy, a lumpectomy followed by partial breast radiation targets a specific area, instead of the entire organ.
Post-lumpectomy patients have the option of APBI or whole-breast irradiation. Both methods are used to prevent the recurrence of cancer. However, the latter option can be expensive and inconvenient for patients. The standard course of treatment for whole-breast irradiation lasts five to seven weeks, requiring return visits five days a week for over a month. Partial breast radiation treatments are generally completed in less than one week.
Travel restrictions or medical conditions can prohibit some women from returning for follow-up treatment. By shortening the treatment time with APBI and less-invasive application methods like SAVI, patients are more likely to get the care they need.
Unlike interstitial brachytherapy - therapy where a radioactive source is placed in or near an area requiring treatment - which requires numerous catheters to be placed through the breast and intracavitary brachytheraphy in which the radiation dosage cannot be customized, the SAVI applicator is inserted through a single incision and its array of catheters allows control of the radiation placement.
Unexpanded, the device looks like a bundle of tubes. Three models range in diameter size from three to five centimeters. Once inserted into the lumpectomy cavity, the physician expands the catheters by turning a mechanism. The elliptical-shaped expansion fills the cavity. Radiation can be delivered to all or some of the catheters, avoiding damage to nearby health tissue. The applicator remains in place until treatment is concluded, at which time it is removed and the small incision taped closed.
APBI and the three different methods of treatment is not appropriate for all women, Yashar said. SAVI candidates must be in the early stages of breast cancer and the tumor bed has to fit certain dimensional parameters. The cavity cannot be too large or small, and some tumor shapes, such as cylindrical, are not compatible with the shape of the applicator.
“Choosing treatment is like a decision tree,” Yashar said.
At the trunk, patients must choose a mastectomy or lumpectomy. That branches off to a choice about radiation or no radiation, which sprouts into a decision about whole-breast radiation or partial breast radiation. The twigs growing off of that branch are interstitial brachytherapy, intracavitary brachytheraphy or SAVI.
Yashar said she is excited to offer another choice to women faced with the fear and worry brought on by breast cancer.
“That’s what universities are about,” she said. “Making things a little bit better.”
For more information call (858) 822-4135 or visit https://radonc.ucsd.edu/treatments/savi.asp.