Five day radiation option for women with breast cancer

August 26, 2015
Research shows that 90% of all local breast cancer recurrences happen within one centimeter from where the cancer was removed. Could we focus the radiation treatment into that area at highest risk but spare the remaining breast tissue?

I am excited to report that we have recently added a new breast cancer radiation treatment alternative for patients treated at the Swedish Cancer Institute. SAVI is a form of accelerated partial breast radiation that provides an alternative to the 6 weeks of treatment usually recommended to breast cancer patients. About a week after surgery, once we know that the cancer has been completely removed, a catheter is placed into the breast to deliver radiation treatment directly into the surgical cavity. Treatment now is delivered over five days instead of the standard 6-7 weeks of daily sessions.

Decades ago, breast cancer surgeons recognized that removing the whole breast in many breast cancer patients was an unnecessarily large and disfiguring procedure for the majority of breast cancer patients. Mastectomies, for many women, were replaced by “lumpectomies” where the unhealthy area with the cancer was removed but the unaffected breast tissue was left in place. Finally, the science showed that there was no survival benefit to removing all of the extra healthy tissue. It was found, though, that the risks of having the cancer recur near the original tumor was fairly high when only a lumpectomy was used. When the surgery was combined with radiation treatment, the risk of local recurrence dropped to near that of what a woman would have faced with a mastectomy. Patients are treated with surgery plus radiation – but in that past that had meant going in every day for 7 weeks to receive whole breast radiation treatment. 

As technology advanced, the opportunity developed to provide high doses of radiation directly into the space where the cancer had been located. Using special catheters, the treatment length now shrinks from 7 weeks to just 5 days. Because the radiation treatment is concentrated in the breast tissue, the surrounding damage to the skin, lung, heart, ribs and healthy breast tissue is minimized. 

Potential candidates for this new treatment:
  • Have a single breast cancer measuring less than 3 cm in size 
  • Currently, patients need to be over the age or 50 
The first step is to go to the operating room for an outpatient surgery to have the cancer removed. Once the final pathology shows there aren’t any cancer cells close to or touching the edges of what was removed, the patient comes to the office to the have the catheter inserted.

After receiving some relaxation medication, numbing medication is injected and an ultrasound is used to identify the cavity where the cancer used to be located. A small incision is made in the skin a few centimeters away from the cavity and the catheter is inserted through that incision and into the cavity. 

Once the catheter is in place, you cannot get that part of your body wet until after it has been removed (usually 7-10 days).
A CT scan confirms that the device is in place and that it fills the cavity in such a way that the radiation dose will deliver treatment to all the edges.

Treatment then is done twice daily for five days. During that time, you want to avoid any trauma to the area but no major restrictions are placed on your activities. After your afternoon treatment on the fifth day, the device is removed. Typically, from surgery to your last radiation treatment is within 3 weeks.

The outcomes for this procedure are excellent. A multicenter study, published this past April in the Annals of Surgical Oncology, demonstrated the treatment resulted in excellent long-term local control and cosmetic outcomes. This method is a great option for many women, especially for those who have busy work or family schedules or live a distance from the radiation center. 

For more information, please contact our office at 206-215-6400.

Topics: Cancer, Women