Outcomes in Patients Treated with Post-mastectomy Chest Wall Radiotherapy without the Routine Use of Bolus

Quantitative Effect of Bolus on Skin Dose in Postmastectomy Radiation Therapy

“…Owing to higher recurrence rates in tumours with skin involvement, it is important to ensure the skin is being adequately dosed. However, some literature suggests that differences in skin dose may not influence rates of locoregional recurrence [6,15,17,18,20]. Despite these findings, bolus is still widely used and it should be noted that most published data on this topic comes from small case-control studies retrospectively comparing separate groups of patients [6,14,15].…”

“…One study by Yap et al compared their results in treatment without bolus with previous literature. This methodology potentially introduces confounders and heterogeneity in data collection of patient and treatment factors [20]. With the present study, we aimed to examine dose to the skin in a controlled setting, using patients as their own controls with respect to dosimetric endpoints in the treatment plans.…”

A Delphi study and International Consensus Recommendations: The use of bolus in the setting of postmastectomy radiation therapy for early breast cancer

“…Bolus serves as a tissue equivalent material that shifts the 95-100% isodose towards the skin and subcutaneous tissue (depending on the thickness of bolus and subcutaneous tissue) [1]. The need for bolus for all breast cancer patients planned for PMRT has been questioned due to skin toxicity as seen in a number of studies [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], clinician surveys [21][22][23][24][25], and national guidelines [26]. All studies showed huge variability in terms of bolus indications and use, with no proven optimum regimen pertaining to thickness, schedule (i.e., daily, alternating days), bolus material, and RT planning characteristics (such as beam energy)…”

In search of a one plan solution for VMAT post‐mastectomy chest wall irradiation

“…Regardless of planning technique, to date, there has been a lack of consensus on whether the routine use of bolus in post-mastectomy radiation therapy is necessary or not. 9,10 The guidelines of the American Society of Clinical Oncology first published in 2001 11 and later updated in 2016 12 stated that "whether it is necessary to apply the bolus every day, less frequently, or at all is uncertain." As such, whether bolus is used routinely or not, its thickness and frequency are often decided by clinical experience and vary from center to center.…”