Quantitative Effect of Bolus on Skin Dose in Postmastectomy Radiation Therapy.
Adult
Aged
Aged, 80 and over
Breast Neoplasms
/ radiotherapy
Dose-Response Relationship, Radiation
Female
Humans
Mastectomy
Middle Aged
Quality of Life
Radiodermatitis
/ etiology
Radiotherapy Dosage
Radiotherapy, Adjuvant
/ adverse effects
Retrospective Studies
Risk Factors
Skin
/ radiation effects
Thoracic Wall
/ radiation effects
Breast cancer
bolus
postmastectomy radiation therapy
skin dosimetry
Journal
Journal of medical imaging and radiation sciences
ISSN: 1876-7982
Titre abrégé: J Med Imaging Radiat Sci
Pays: United States
ID NLM: 101469694
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
05
03
2020
revised:
05
06
2020
accepted:
08
06
2020
pubmed:
11
7
2020
medline:
27
8
2021
entrez:
11
7
2020
Statut:
ppublish
Résumé
In postmastectomy radiation therapy (PMRT), some centres prescribe the use of a tissue-equivalent bolus to the skin to reduce the risk of chest wall recurrence. The addition of bolus causes an increase in the skin dose, which may lead to increased risk of radiodermatitis. Radiodermatitis can decrease patients' overall quality of life, bringing into question the benefit of using the bolus. The purpose of this retrospective chart review was to quantify the increase in skin dose associated with the use of bolus in the PMRT setting. We evaluated 70 patients who underwent PMRT at our institution during 2012-2018. Two similar treatment plans were generated for each patient: one with bolus and one without. Skin dose-volume histogram values were evaluated, and statistical analysis was performed using MATLAB R2015b. There was no significant difference in the maximum skin dose within a depth of 5 mm for bolus versus nonbolus plans (P = 0.4). However, within a depth of 3 mm, bolus plans had a maximum skin dose 7% ± 2.5% higher than the nonbolus plans (P < .00001). Mean skin dose within depths of 3 and 5 mm were both significantly higher (P < .00001) for bolus plans. The photon beam energy and chest wall separation showed minimal or no effect on skin dose. Given the differing opinions in the literature regarding the role for bolus in PMRT, there is still uncertainty of the optimal treatment method. This retrospective study demonstrates a 20%-30% reduction in mean skin dose when bolus is not used.
Sections du résumé
BACKGROUND
In postmastectomy radiation therapy (PMRT), some centres prescribe the use of a tissue-equivalent bolus to the skin to reduce the risk of chest wall recurrence. The addition of bolus causes an increase in the skin dose, which may lead to increased risk of radiodermatitis. Radiodermatitis can decrease patients' overall quality of life, bringing into question the benefit of using the bolus. The purpose of this retrospective chart review was to quantify the increase in skin dose associated with the use of bolus in the PMRT setting.
MATERIALS AND METHODS
We evaluated 70 patients who underwent PMRT at our institution during 2012-2018. Two similar treatment plans were generated for each patient: one with bolus and one without. Skin dose-volume histogram values were evaluated, and statistical analysis was performed using MATLAB R2015b.
RESULTS
There was no significant difference in the maximum skin dose within a depth of 5 mm for bolus versus nonbolus plans (P = 0.4). However, within a depth of 3 mm, bolus plans had a maximum skin dose 7% ± 2.5% higher than the nonbolus plans (P < .00001). Mean skin dose within depths of 3 and 5 mm were both significantly higher (P < .00001) for bolus plans. The photon beam energy and chest wall separation showed minimal or no effect on skin dose.
CONCLUSION
Given the differing opinions in the literature regarding the role for bolus in PMRT, there is still uncertainty of the optimal treatment method. This retrospective study demonstrates a 20%-30% reduction in mean skin dose when bolus is not used.
Identifiants
pubmed: 32646668
pii: S1939-8654(20)30151-X
doi: 10.1016/j.jmir.2020.06.006
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
462-469Informations de copyright
Copyright © 2020. Published by Elsevier Inc.