Table of ContentsView AllTable of ContentsWhom It’s ForHow It WorksHow It ComparesProcedureSide EffectsContraindicationsFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Whom It’s For
How It Works
How It Compares
Procedure
Side Effects
Contraindications
Frequently Asked Questions
Strut-adjusted volume implant (SAVI)brachytherapyuses an implanted device that delivers radiation internally. Brachytherapy is also known as internal radiation therapy.
SAVI is often used after alumpectomy(removing abnormal tissue or cancer from the breast) in those diagnosed with early-stagebreast cancer.This type of brachytherapy is different fromexternal beam radiation, which applies radiation from outside the body and can cause damage to underlying tissues of the breast, lung, and ribcage.
SAVI reduces the length of therapy from up to seven weeks for traditional whole-breast irradiation to just one week or less.This short-course approach is known as accelerated partial breast irradiation (ABPI).
This article will explain when SAVI is used, how it works, and what to expect from the procedure.
Verywell / Emily Roberts
Because the SAVI device volume is customizable, it can be used to treat cavities of varied sizes or irregular shapes after surgery.
The SAVI system consists of a tube-like applicator (called atrocar), an expandable bundle of tiny catheters, and a computerized radiation delivery system. The bundled catheters are positioned around the applicator pole like the ribs of an umbrella.
Once the device is inserted through a small incision in the breast, the pole is partially retracted, causing the catheters to expand into a ball shape. The tiny catheters are soft and flexible, and able to conform to the shape of the surgical cavity, providing a snug fit.
According to a 2016 study in the journalBrachytherapy, SAVI-based APBI achieved a four-year survival rate of between 92% and 98% in the 250 women studied. Of these, only 2.3% experienced a cancer recurrence.
Potential Advantages
The SAVI device received 510(k) clearance from the Food and Drug Administration (FDA) in 2006.The classification is used for medical devices that are considered safe and “substantially equivalent” to similar devices in current use.
Compared to other methods of radiation therapy, advantages include:
As opposed tointerstitial brachytherapy, which involves the insertion of multiple tubes (catheters) in and around a tumor, the SAVI system only requires a single entry point.
SAVI-based APBI, like other forms of brachytherapy, reduces many of the characteristic risks of external beam radiation. These include skin changes (which sometimes are permanent), hardening of breast tissue (called radiation fibrosis), spider veins (telangiectasia), changes in breast shape, localized nerve damage (brachial plexopathy), and damage to underlying bone and lung tissues.
Long-Term Side Effects of Radiation Therapy
SAVI brachytherapy is a two-part procedure involving the implantation of the SAVI device and the actual radiation therapy delivered. This typically involves a team of providers, including aradiation oncologist(medical doctor who specializes in treating cancer patients with radiation), adosimetrist(radiation oncology professional who creates a plan to deliver radiation doses), aradiation therapist(medical professional who assists in administering radiation), and a nurse.
Preparation
The SAVI device can be placed during the lumpectomy or afterward in a separate procedure. The latter can be performed as an in-office procedure or in an outpatient clinic.
Before insertion, the breast is evaluated with anultrasoundto determine the size and shape of the surgical cavity. Four different sizes of the implantable device are available.
If the procedure is done on an outpatient basis, a topicallidocaine anestheticis used to numb the incision area. A sharp, tube-like trocar is then inserted into the breast under the guidance of an ultrasound (method that uses sound waves to produce images of structures within the body). Next, the SAVI device is fed through the trocar and expanded until it fully conforms to the space.
After the trocar is removed, the incision site is secured with sterile dressing; no sutures (stitches) are needed. Only a small bundle of catheter ends extends outside of the breast.
Radiation
Once the SAVI device is in place, you will go to your radiation oncologist to start treatment. The radiation is delivered twice daily for about five days in a specialized radiology facility.Some cancers may require only three to four days of treatment; others may need up to seven.
The seeds are left in place for 10 minutes and then removed. Upon the completion of a dose, the seeds are withdrawn and reinserted six hours later, for a total of two treatments per day.
After your final round of radiation is complete, the oncologist will remove the SAVI device. This can be done with or without lidocaine in about two minutes. ASteri-Stripis used to close the incision site. A bandage or dressing is then placed on top and you’ll be free to go. One or more follow-up visits will be scheduled to ensure that the incision is properly healed.
Compared to external beam radiation, the side effects of SAVI brachytherapy are far less significant. Fatigue is a common radiation-associated side effect and generally resolves within several days of the completion of therapy.
As with any surgical procedure, there is a risk of infection. To avoid this potential issue, follow your healthcare provider’s recommendations and these tips:
In rare instances, the implantation of the SAVI device can cause aseroma, a pocket of fluid beneath the skin that may require drainage as well as a course oforal antibiotics.
Call your healthcare provider immediately if you develop a high fever, a pus-like discharge, and/or persistent or worsening pain, redness, and swelling around the incision site.
As attractive an option as SAVI brachytherapy may be, it is only indicated for the treatment of early-stage breast cancer. The procedure is best suited for women over age 50 whose tumors have well-defined margins. While not entirely contraindicated in younger women, SAVI may not be suitable for those under the age of 40 years old.
Some of the factors that might exclude you as a candidate include:
The presence of a positive lymph node is a contraindication for SAVI brachytherapy.
Summary
SAVI brachytherapy is often an effective treatment option for those with early-stage breast cancer. This type of internally delivered radiation typically provides improved treatment outcomes with fewer reported side effects compared to external, whole-breast radiation. Always discuss all available treatment options and potential side effects in-depth with your healthcare provider to determine the best option for your individual situation.
A Word From Verywell
SAVI brachytherapy is available across North America, but not at every cancer center. There may be factors that exclude you from treatment, but local availability shouldn’t be one of them. If you live outside of a major urban center and have limited options for radiation therapy, you may want to consider traveling for the five- to seven-day course of SAVI brachytherapy rather than submitting to whole-breast irradiation closer to home.
The term “SAVI” is short for “strut-adjusted volume implant.” This implanted, specialized device is used to deliver internal radiation therapy (brachytherapy). The struts (parts of the device that can be adjusted in size) allow your radiation oncologist to expand the device to fit the breast cavity as part of treatment.
Often performed as an outpatient, same-day procedure, implantation of a SAVI device typically takes about 20 minutes. The procedure is done under guidance of ultrasound using a small incision to place the device.
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Manoharan SR, Rodriguez RR, Bobba VS, Chandrashekar M.Dosimetry evaluation of SAVI-based HDR brachytherapy for partial breast irradiation.J Med Phys. 2010;35(3):131-136. doi:10.4103/0971-6203.62127Lu SM, Scanderbeg DJ, Barna P, Yashar W, Yashar C.Evaluation of two intracavitary high-dose-rate brachytherapy devices for irradiating additional and irregularly shaped volumes of breast tissue.Med Dosim. 2012;37(1):9-14. doi:10.1016/j.meddos.2010.12.005Thomas MA, Ochoa LL, Zygmunt TM, et al.Accelerated partial breast irradiation: A safe, effective, and convenient early breast cancer treatment option.Mo Med. 2015 Sep-Oct;112(5):379–384.Yashar C, Attai D, Butler E, et al.Strut-based accelerated partial breast irradiation: Report of treatment results for 250 consecutive patients at 5 years from a multicenter retrospective study.Brachytherapy. 2016;15(6):780-787. doi:10.1016/j.brachy.2016.07.002Food and Drug Administration.510(k) premarket notification.Merit Medical Systems.Three-fraction SAVI brachytherapy: Reducing patient interactions during COVID-19.Sayan M, Wilson K, Nelson C, Gagne H, Rubin D, Heimann R.A novel schedule of accelerated partial breast radiation using intensity-modulated radiation therapy in elderly patients: survival and toxicity analysis of a prospective clinical trial.Radiat Oncol J. 2017;35(1):32–38. doi:10.3857/roj.2016.01963Correa C, Harris E, Leonardi M, et al.Accelerated partial breast irradiation: Executive summary for the update of an ASTRO evidence-based consensus statement.Pract Radiat Oncol. 2017;7(2):73-79. doi:10.1016/j.prro.2016.09.007Additional ReadingGabani P, Cyr A, Zoberi J, et al.Long-term outcomes of APBI via multicatheter interstitial HDR brachytherapy: Results of a prospective single-institutional registry.Brachytherapy. 2018 Jan-Feb;17(1):171-80. doi: 10.1016/j.brachy.2017.09.009.Hepel J, Arthur J, Shaitelman S, et al.American Brachytherapy Society consensus report for accelerated partial breast irradiation using interstitial mutlicatheter brachytherapy.Brachytherapy. 2017 Sep-Oct;16(5):919-28. doi: 10.1016/j.brachy.2017.05.012.Polgar C, Ott O, Hildebrandt G, et al.Late side-effects and cosmetic results of accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the breast.Lancet Oncol. 2017;18(2):259-68. doi: 10.1016/s1470-2045%2817%2930011-6.
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Manoharan SR, Rodriguez RR, Bobba VS, Chandrashekar M.Dosimetry evaluation of SAVI-based HDR brachytherapy for partial breast irradiation.J Med Phys. 2010;35(3):131-136. doi:10.4103/0971-6203.62127Lu SM, Scanderbeg DJ, Barna P, Yashar W, Yashar C.Evaluation of two intracavitary high-dose-rate brachytherapy devices for irradiating additional and irregularly shaped volumes of breast tissue.Med Dosim. 2012;37(1):9-14. doi:10.1016/j.meddos.2010.12.005Thomas MA, Ochoa LL, Zygmunt TM, et al.Accelerated partial breast irradiation: A safe, effective, and convenient early breast cancer treatment option.Mo Med. 2015 Sep-Oct;112(5):379–384.Yashar C, Attai D, Butler E, et al.Strut-based accelerated partial breast irradiation: Report of treatment results for 250 consecutive patients at 5 years from a multicenter retrospective study.Brachytherapy. 2016;15(6):780-787. doi:10.1016/j.brachy.2016.07.002Food and Drug Administration.510(k) premarket notification.Merit Medical Systems.Three-fraction SAVI brachytherapy: Reducing patient interactions during COVID-19.Sayan M, Wilson K, Nelson C, Gagne H, Rubin D, Heimann R.A novel schedule of accelerated partial breast radiation using intensity-modulated radiation therapy in elderly patients: survival and toxicity analysis of a prospective clinical trial.Radiat Oncol J. 2017;35(1):32–38. doi:10.3857/roj.2016.01963Correa C, Harris E, Leonardi M, et al.Accelerated partial breast irradiation: Executive summary for the update of an ASTRO evidence-based consensus statement.Pract Radiat Oncol. 2017;7(2):73-79. doi:10.1016/j.prro.2016.09.007Additional ReadingGabani P, Cyr A, Zoberi J, et al.Long-term outcomes of APBI via multicatheter interstitial HDR brachytherapy: Results of a prospective single-institutional registry.Brachytherapy. 2018 Jan-Feb;17(1):171-80. doi: 10.1016/j.brachy.2017.09.009.Hepel J, Arthur J, Shaitelman S, et al.American Brachytherapy Society consensus report for accelerated partial breast irradiation using interstitial mutlicatheter brachytherapy.Brachytherapy. 2017 Sep-Oct;16(5):919-28. doi: 10.1016/j.brachy.2017.05.012.Polgar C, Ott O, Hildebrandt G, et al.Late side-effects and cosmetic results of accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the breast.Lancet Oncol. 2017;18(2):259-68. doi: 10.1016/s1470-2045%2817%2930011-6.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Manoharan SR, Rodriguez RR, Bobba VS, Chandrashekar M.Dosimetry evaluation of SAVI-based HDR brachytherapy for partial breast irradiation.J Med Phys. 2010;35(3):131-136. doi:10.4103/0971-6203.62127Lu SM, Scanderbeg DJ, Barna P, Yashar W, Yashar C.Evaluation of two intracavitary high-dose-rate brachytherapy devices for irradiating additional and irregularly shaped volumes of breast tissue.Med Dosim. 2012;37(1):9-14. doi:10.1016/j.meddos.2010.12.005Thomas MA, Ochoa LL, Zygmunt TM, et al.Accelerated partial breast irradiation: A safe, effective, and convenient early breast cancer treatment option.Mo Med. 2015 Sep-Oct;112(5):379–384.Yashar C, Attai D, Butler E, et al.Strut-based accelerated partial breast irradiation: Report of treatment results for 250 consecutive patients at 5 years from a multicenter retrospective study.Brachytherapy. 2016;15(6):780-787. doi:10.1016/j.brachy.2016.07.002Food and Drug Administration.510(k) premarket notification.Merit Medical Systems.Three-fraction SAVI brachytherapy: Reducing patient interactions during COVID-19.Sayan M, Wilson K, Nelson C, Gagne H, Rubin D, Heimann R.A novel schedule of accelerated partial breast radiation using intensity-modulated radiation therapy in elderly patients: survival and toxicity analysis of a prospective clinical trial.Radiat Oncol J. 2017;35(1):32–38. doi:10.3857/roj.2016.01963Correa C, Harris E, Leonardi M, et al.Accelerated partial breast irradiation: Executive summary for the update of an ASTRO evidence-based consensus statement.Pract Radiat Oncol. 2017;7(2):73-79. doi:10.1016/j.prro.2016.09.007
Manoharan SR, Rodriguez RR, Bobba VS, Chandrashekar M.Dosimetry evaluation of SAVI-based HDR brachytherapy for partial breast irradiation.J Med Phys. 2010;35(3):131-136. doi:10.4103/0971-6203.62127
Lu SM, Scanderbeg DJ, Barna P, Yashar W, Yashar C.Evaluation of two intracavitary high-dose-rate brachytherapy devices for irradiating additional and irregularly shaped volumes of breast tissue.Med Dosim. 2012;37(1):9-14. doi:10.1016/j.meddos.2010.12.005
Thomas MA, Ochoa LL, Zygmunt TM, et al.Accelerated partial breast irradiation: A safe, effective, and convenient early breast cancer treatment option.Mo Med. 2015 Sep-Oct;112(5):379–384.
Yashar C, Attai D, Butler E, et al.Strut-based accelerated partial breast irradiation: Report of treatment results for 250 consecutive patients at 5 years from a multicenter retrospective study.Brachytherapy. 2016;15(6):780-787. doi:10.1016/j.brachy.2016.07.002
Food and Drug Administration.510(k) premarket notification.
Merit Medical Systems.Three-fraction SAVI brachytherapy: Reducing patient interactions during COVID-19.
Sayan M, Wilson K, Nelson C, Gagne H, Rubin D, Heimann R.A novel schedule of accelerated partial breast radiation using intensity-modulated radiation therapy in elderly patients: survival and toxicity analysis of a prospective clinical trial.Radiat Oncol J. 2017;35(1):32–38. doi:10.3857/roj.2016.01963
Correa C, Harris E, Leonardi M, et al.Accelerated partial breast irradiation: Executive summary for the update of an ASTRO evidence-based consensus statement.Pract Radiat Oncol. 2017;7(2):73-79. doi:10.1016/j.prro.2016.09.007
Gabani P, Cyr A, Zoberi J, et al.Long-term outcomes of APBI via multicatheter interstitial HDR brachytherapy: Results of a prospective single-institutional registry.Brachytherapy. 2018 Jan-Feb;17(1):171-80. doi: 10.1016/j.brachy.2017.09.009.Hepel J, Arthur J, Shaitelman S, et al.American Brachytherapy Society consensus report for accelerated partial breast irradiation using interstitial mutlicatheter brachytherapy.Brachytherapy. 2017 Sep-Oct;16(5):919-28. doi: 10.1016/j.brachy.2017.05.012.Polgar C, Ott O, Hildebrandt G, et al.Late side-effects and cosmetic results of accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the breast.Lancet Oncol. 2017;18(2):259-68. doi: 10.1016/s1470-2045%2817%2930011-6.
Gabani P, Cyr A, Zoberi J, et al.Long-term outcomes of APBI via multicatheter interstitial HDR brachytherapy: Results of a prospective single-institutional registry.Brachytherapy. 2018 Jan-Feb;17(1):171-80. doi: 10.1016/j.brachy.2017.09.009.
Hepel J, Arthur J, Shaitelman S, et al.American Brachytherapy Society consensus report for accelerated partial breast irradiation using interstitial mutlicatheter brachytherapy.Brachytherapy. 2017 Sep-Oct;16(5):919-28. doi: 10.1016/j.brachy.2017.05.012.
Polgar C, Ott O, Hildebrandt G, et al.Late side-effects and cosmetic results of accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the breast.Lancet Oncol. 2017;18(2):259-68. doi: 10.1016/s1470-2045%2817%2930011-6.
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