SAVI Device For Reducing Breast Cancer Recurrence

Pros and Cons of The SAVI Brachytherapy Device for APBI

If your radiation oncologist has recommended the SAVI breast brachytherapy device for your breast cancer, you probably have a lot of questions. Accelerated partial breast irradiation (APBI) is one option if you have had a lumpectomy for breast cancer. What should you know about this device and what can you expect from treatment? How effective is this approach relative to more traditional types of radiation therapy? Let's talk about how the SAVI brachytherapy device works, and the possible advantages and disadvantages you should consider when making your decision.

The goal behind radiation therapy after a lumpectomy is to help prevent the recurrence of your breast cancer. It is actually the recurrence of breast cancer which is responsible for most deaths from the disease. Breast-conserving surgery such as lumpectomy is less invasive than a mastectomy and is on par with survival as long as it is followed by radiation treatments to kill off any possible remaining breast cancer cells. The negative aspect of this, however, is that radiation therapy can damage normal tissue. Brachytherapy, or internally-delivered radiation, is a technique that may spare healthy tissue while treating the tissue around your tumor cavity.

Fighting Breast Cancer From the Inside

What is SAVI brachytherapy for breast cancer?. Credit: Istockphoto.com/Stock Photo©Stephanie Zieber

Radiation treatments for breast cancer can be given with external or internal radiation.

External radiation, also called whole-breast irradiation (WBI), treats the whole breast from the outside, by aiming highly penetrating x-rays at your tumor cavity.

Breast brachytherapy, also called interstitial brachytherapy, is an internal form of radiation which uses special catheters (tiny tubes) to deliver radiation from within your breast to your tumor cavity and a small amount of surrounding tissue.

Accelerated Partial Breast Irradiation (APBI)

We will be talking about the SAVI device for accelerated partial breast irradiation (APBI), but it's important to note that APBI can be performed as either a form of external radiation, or as a form of internal radiation or brachytherapy as with the SAVI device.

External partial breast irradiation is also sometimes performed, though primarily at cancer centers which also perform brachytherapy APBI. Compared with whole breast external radiation therapy, initial studies found that external APBI is associated with a higher risk of local recurrence as well as a greater risk of a new primary cancer developing in the same breast as the original cancer.

Relative to external whole breast radiation therapy, external APBI appears to be associated with a poorer cosmetic result but with less skin toxicity. In studies, external APBI was used most often for women with small tumors that were node negative, estrogen receptor positive, and HER2 negative.

On a positive note, APBI can be conducted in a much shorter time period, theoretically improving fatigue and quality of life.

Though the use of external APBI is currently surrounded by controversy, some major cancer centers are studying ways to improve local control with this type of radiation.

Let's now look at internal (brachytherapy) APBI with the SAVI device.

SAVI™ Accelerated Partial Breast Irradiation (APBI)

SAVI Radiation Applicator
SAVI Radiation Applicator. Credit: SAVI Applicator - Photo © Cianna Medical

The SAVI, which was was FDA approved in 2006, is a breast radiation device that can be custom-fitted to your lumpectomy cavity, regardless of what shape or size it may be.

This device is a bundle of soft, tiny catheters. The SAVI is inserted through a small incision, and the catheter bundle expands uniformly, but its unique design allows it to be opened in a way that truly conforms to the size and shape of your tumor cavity.

The radiation dose can be individually controlled through each catheter, allowing precise targeting by the radiation oncologist. This device is more customizable than a traditional balloon catheter device so women with small breasts may be eligible for this type of treatment. 

What You Can Expect From A SAVI Applicator

SAVI Radiation Applicator Placement
SAVI Radiation Applicator Placement. Credit: Placement - Photo © Cianna Medical

Your surgeon can place a SAVI radiation applicator at the time of your lumpectomy, or it may be inserted during a separate surgery. Only a small incision is needed, to allow the compact catheter bundle to be placed within your breast. The incision area will be secured with a dressing, and part of each catheter line will extend outside your breast until your treatment is complete.

The catheters are very flexible and soft, so they should be comfortable for you during the 5 to 7 days of radiation. Your site dressings will be changed twice a day during treatment, and must be kept dry. To prevent infections, you may be given antibiotics to take.

Within this device are small brachytherapy seeds (radioactive pellets each about the size of a grain of rice).

Radiation Dosing During Treatments

SAVI Radiation Applicator Dosing
SAVI Radiation Applicator Dosing. Credit: Dosing - Photo © Cianna Medical

You will report to your radiation oncology facility twice a day for 5 to 7 days, to have treatments. Plan on spending about 30 minutes for each visit; about 5-10 minutes of your appointment will be used for the radiation treatment time. Your radiation oncology team will make you comfortable, and connect your SAVI applicator to the radiation source.

During each treatment, the radiation source is sent down each catheter one at a time. A different amount of radiation ​will be given at different points along the length of each catheter. This gives you the best dose for the affected tissue, and the most protection for surrounding healthy tissue.

Completing Radiation and Removing Your SAVI Applicator

SAVI Radiation Applicator Removal
SAVI Radiation Applicator Removal. Credit: Removal - Photo © Cianna Medical

After your final radiation treatment, your radiation oncologist can remove the SAVI device. It should take about two minutes to remove the device, clean your incision site, and close the skin with adhesive strips. A bandage or dressing be placed on top, and you will be free to go. Be sure to go to your follow-up visits, so your doctor can see that your incision is healing properly.

Effectiveness

Breast cancer. Credit: Chicago Tribune / Contributor / Getty Images

Since breast accelerated partial breast irradiation (brachytherapy or APBI) was first approved in 2002, doctors have found that this treatment provides a high rate of tumor control for those with early-stage breast cancer, and who are appropriate candidates for its use.

Compared to whole breast irradiation which results in a 2 percent later need for mastectomy, APBI resulted in a mastectomy rate of only 4 percent.  The SAVI brachytherapy device appears to work very well when compared with alternative devices currently available.

Breast Brachytherapy Advantages

Breast Radiotherapy. Credit: BSIP / Contributor / Getty Images

When choosing a type of radiation therapy, it can be helpful to list out the advantages and disadvantages of each treatment. Of course, the pros and cons aren't usually of equal importance, and you may end up choosing a therapy that had more cons than pros. Some of the advantages of breast brachytherapy include:

  • Damage to healthy tissue. Whole-breast irradiation (external radiation) affects healthy tissue as well as cancer cells and may cause side effects in healthy tissue. Breast brachytherapy is designed to cause less damage to healthy tissue.
  • Frequency of treatment. Whole breast radiation treatments are usually given daily Monday through Friday for about 6 weeks. With breast brachytherapy, treatment can usually be completed in a 5 to 7 day period. Breast brachytherapy affects a smaller amount of breast tissue and delivers a targeted dose of radiation to your lumpectomy site.
  • Recovery time. Recovery time is usually faster with breast brachytherapy than with whole breast irradiation.
  • Side effects. In general, side effects such as fatigue are minimal with breast brachytherapy.

Disadvantages of Breast Brachytherapy

Just as there are advantages of breast brachytherapy, there can be disadvantages as well. These may include:

  • Risk of breast cancer recurrence. As noted under effectiveness, the risk of breast cancer recurrence is slightly higher with breast brachytherapy. That said, there is currently no evidence that this higher rate of recurrence has any effect on outcomes.
  • Risk of infection. Due to the presence of tubes entering your skin, the risk of infection is higher than with external radiation, though small.
  • Comfort. Some people find the device uncomfortable.
  • Late effects. The long-term cosmetic and late effects can be somewhat higher with breast brachytherapy, though it appears to have less skin toxicity (less chance of redness and rashes).
  • Availability. External radiation therapy is more widely available than breast brachytherapy.

Is SAVI Available to Me?

Woman In Consultation. Credit: BSIP / Contributor / Getty Images

SAVI breast brachytherapy is available across America, but it's not available at every cancer center.  It will work for large or small breasts, but other factors may make it unsuitable for some people. Check with your doctor about the option of accelerated partial breast irradiation.

A Word From Verywell on Savi Brachytherapy for Breast Cancer

Many new options have become available for treating breast cancer in recent years. While this is wonderful, it also means more decisions. It's more important than ever for people with cancer to learn about their disease and play an active role in their cancer care team. 

Every treatment has risks and benefits, and what is right for one person may not be for another. Be your own advocate for your cancer care and choose the treatments which feel most comfortable for you as an individual and not someone else. Making your own decisions about breast cancer treatments is one way to honor yourself through treatment and beyond.

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