The use of bolus in postmastectomy radiation therapy for breast cancer: A systematic review

Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy

“…Therefore, current European consensus guidelines do not recommend a bolus unless deemed necessary to ensure that the therapeutic dose of irradiation adequately covers those areas at high-risk for recurrence, e.g., in skin invading cancer [ 53 ]. Moreover, data on safety and efficacy in the setting of breast reconstruction is lacking [ 54 ]. Nonetheless, a boost in this setting was commonly practiced to enhance radiation dosage to the mastectomy scar in order to reduce local recurrence [ 55 ].…”

Postmastectomy Radiation Therapy Bolus Associated Complications in Patients Who Underwent 2-stage Breast Reconstruction

“…In a recent review, bolus was shown to increase complications without demonstrating benefit in local control 14 .…”

“…The use of bolus has not been prospectively evaluated in randomized controlled trials but it is usually recommended for patients with cutaneous involvement to ensure skin coverage 9 10 . However, its usage varies widely across radiation oncologists 11 and it has been shown to increase radiation-related toxicities 12 and treatment interruptions 13 without a proven benefit in local control rates 14 . To date, data specifically regarding the association between the use of bolus in PMRT and two-stage breast reconstruction complications are lacking 14 .…”

“…However, its usage varies widely across radiation oncologists 11 and it has been shown to increase radiation-related toxicities 12 and treatment interruptions 13 without a proven benefit in local control rates 14 . To date, data specifically regarding the association between the use of bolus in PMRT and two-stage breast reconstruction complications are lacking 14 .…”

“…9 , 10 However, its usage varies widely across radiation oncologists, 11 and has been shown to increase radiation-related toxicities 12 and treatment interruptions 13 without a proven benefit in local control rates. 14 To date, data specifically regarding the association between the use of bolus in PMRT and 2-stage breast reconstruction complications are lacking. 14 Therefore, we retrospectively evaluated the association of skin bolus in PMRT and reconstruction complications in patients with breast cancer who underwent 2-stage reconstruction at a cancer center.…”