Initial clinical experience with the Strut-Adjusted Volume Implant brachytherapy applicator for accelerated partial breast irradiation
Received 11 February 2009; received in revised form 24 March 2009; accepted 26 March 2009. published online 10 September 2009.
Abstract
Purpose
Accelerated partial breast irradiation is becoming increasingly popular. The Cianna single-entry high-dose-rate applicator, Strut-Adjusted Volume Implant (SAVI, Cianna Medical, Aliso Viejo, CA), contains peripheral struts allowing greater planning flexibility for small-breasted women, technically easier insertion, and normal tissue exposure minimization. This study evaluates early clinical experience.
Methods and Materials
Thirty patients treated with the SAVI with a median followup of 12 months were evaluated. The median age was 59.5. Tumor size averaged 0.9cm. Fifteen cancers were ductal carcinoma in situ (50%), 1 was invasive lobular (3.3%), 4 were tubular (6.7%), and the rest infiltrating ductal (40%). Most of them were estrogen receptor (ER) positive (90%). Nine women (30%) were premenopausal.
Results
Dosimetry was outstanding with median V90, V150, and V200 of 96.2%, 24.8, and 12.8cc. There were no symptomatic seromas, and one report of asymptomatic fat necrosis seen on mammogram at 1 year. In patients who had skin spacing of less than 1cm, the median skin dose was 245cGy/fraction. The median rib and lung dose per fraction for those patients with either structure less than 1cm was 340 and 255cGy (75% of prescribed dose), respectively. There have been no local recurrences to date.
Conclusions
Early clinical experience with the SAVI demonstrates the ease of placement of a single-entry brachytherapy device combined with the increased dose modulation of interstitial brachytherapy. Dose to normal structures has remained exceedingly low. Almost half of evaluated patients were not candidates for other single-entry brachytherapy devices because of skin spacing or breast size, demonstrating an expansion of candidates for single-entry partial breast brachytherapy.
1Department of Radiation Oncology, University of California San Diego, La Jolla, CA
2Department of Surgery, Division of Surgical Oncology, University of California San Diego, La Jolla, CA
3Department of Surgery, Divisions of Plastics and Surgical Oncology, University of California San Diego, La Jolla, CA
Corresponding author. Department of Radiation Oncology, University of California San Diego, Moores Cancer Center, 3855 Health Sciences Drive #0843, La Jolla, CA 92093-0843. Tel.: +1-858-822-6059; fax: +1-858-822-5568.
ABSTRACT