There are several methods for delivering partial breast irradiation. Among them is Strut Assisted Volume Implant (SAVITM): this device has 7-11 “struts” or catheters through which the iridium seed travels (see photo above). The struts are expanded after the device is inserted into the lumpectomy cavity. The SAVI, which was was FDA approved in 2006, is a breast radiation device that can be custom-fitted to the lumpectomy cavityIt consists of a bundle of soft, tiny catheters inserted through a small incision, and opened in a way that conforms to the size and shape of the tumor cavity.Other devices that can be used for partial radiation are Mammosite, which uses an expandable baloon and COntura TM MLGm which is a baloon with five lumens into which seeds are placed.
The literare is supportive and includes a recommendation of the The American Society of Breast Surgeons (ASBS) for:
a. The patient is 45 years old or greater, and
b. The patient has invasive ductal carcinoma or ductal carcinoma in situ (DCIS), and
c. The total tumor size (invasive and DCIS) is less than or equal to 3 cm in sizeAccelerted Partial Breast Radiotehrapy, and
d. There are negative microscopic surgical margins of excision, and
e. The axillary lymph nodes/sentinel lymph nodes are negative (Not applicable with a diagnosis of DCIS).
A similar recommendationw sa amde by ASTRO in 2009. The Task Force proposed three patient groups: (1) a “suitable” group, for whom APBI outside of a clinical trial is acceptable, (2) a “cautionary” group, for whom caution and concern should be applied when considering APBI outside of a clinical trial, and (3) an “unsuitable” group, for whom APBI outside of a clinical trial is not generally considered warranted. Patients who choose treatment with APBI should be informed that whole-breast irradiation (WBI) is an established treatment with a much longer track record that has documented long-term effectiveness and safety.
The American Society of Breast Surgeons. (2005, December). Consensus statement for accelerated partial breast irradiation. Retrieved from http://www.breastsurgeons.org/apbi.shtml.
Sauer R, Sautter-Bihl ML, Budach W, et al. Accelerated partial breast irradiation: consensus statement of 3 German Oncology societies. Cancer. 2007;110(6):1187–1194.
Smith BD, Arthur DW, Buchholz TA, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys. 2009;74(4):987–1001.
Accelerated Partial Breast Irradiation Consensus Statement From the American Society for Radiation Oncology (ASTRO) International Journal of Radiation Oncology * Biology * Physics
Volume 74, Issue 4 , Pages 987-1001, 15 July 2009