SAVI: A New Way to Treat Early-Stage Breast Cancer

Dr. Cynara Coomer, chief of Breast Surgery at SIUH, demonstrates how the multi-catheter SAVI device expands and conforms to a patient's lumpectomy cavity.

SAVI: A New Way to Treat Early-Stage Breast Cancer

Like clockwork, Martha Caruana went each year for her annual mammogram. But when she lost her job as an administrative assistant at a midtown Manhattan accounting firm last year, the 66-year-old grandmother found herself without health insurance to pay for the breast cancer exam.

The turn of events caused Caruana to wait an additional six months for her mammography. The exam and a follow-up biopsy found that she had ductal carcinoma in situ (DCIS), also known as Stage 0 breast cancer.

While news of breast cancer is never welcome, the fact that it was detected at its earliest stage and confined to the milk duct in her breast was a relief for Caruana.

Martha Caruana describes a new type of partial breast radiation therapy that she received at SIUH.

"I was told that if I had to have any kind of cancer, this was the best type to have," said the Bay Terrace resident.

In March, Caruana underwent a lumpectomy in her right breast.

After breast surgery, patients are often faced with five to six weeks of radiation therapy. But Caruana's treatment was complete in just five days.

That's because she underwent partial breast radiation at Staten Island University Hospital using the SAVI (short for Strut-Adjusted Volume Implant) device, which drastically cuts down on treatment time for patients with early-stage breast cancer. SIUH is the first hospital in New York State to be recognized as a Center of Excellence for the treatment.

"Martha was a very good candidate for partial breast radiation and using the SAVI device because she had DCIS and it was within a small area of her breast," explained Dr. Cynara Coomer, chief of Breast Surgery at SIUH and director of The Comprehensive Breast Center.

Using local anesthesia, Dr. Coomer made a small incision in Caruana's breast and placed the slim SAVI device into her lumpectomy cavity. The device is made up of a bundle of soft and flexible catheters which internally radiate the breast. Once inside the breast, the catheters are expanded to conform to the site.

The dose of radiation is controlled for each of the catheters in the SAVI partial breast radiation device, explained Dr. Cynara Coomer.

"The reason to use a multi-catheter device is that we can control the dose of radiation for each of the catheters, so the catheters that are closest to the skin can get less radiation," said Dr. Coomer. "The catheters that are closest to the breast tissue can get more radiation. So, the tissue that really needs to be radiated can be radiated with the highest dose and that means less exposure to the skin, the chest wall, heart and lungs."

The SAVI device stayed in place throughout the treatment week. A portion of the end of each catheter remained outside Caruana's breast and was secured with dressing and a sports bra.

Caruana's radiation therapy was done twice a day at 8 in the morning and again at 2 in the afternoon. For each session, the hospital's treatment team individually hooked up each catheter to the radiation source. The treatments took between 6 to 10 minutes to radiate the lumpectomy area.

"During the course of the week I was able to do everything. I was able to drive myself back and forth for treatments," said Caruana. "I felt fine. I wasn't sick. I just did everything I normally did. The only thing I had to be careful of was lifting."

Because Caruana had only partial breast radiation, as opposed to radiating her whole breast, she could have a lumpectomy and radiation again should a second breast cancer occur.

Patients who receive radiation to the whole breast and develop another breast cancer can't be radiated again and would have to have a mastectomy, noted Dr. Coomer.

To lessen her chances of a cancer recurrence, Caruana will be taking the anti-estrogen drug Tamoxifen for the next five years.

For women who may be anxious about having the SAVI treatment, Caruana stresses that there is nothing to fear or be nervous about.

Categories: Breast Surgery

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