组织补偿膜使用方式对乳腺癌根治术后胸壁皮肤剂量的影响

doi:10.3969/j.issn.1006-5725.2025.14.003

Abstract

Abstract:

Objective To investigate the impact of different application methods of tissue compensators （bolus） on the skin dose delivered to the chest wall following radical mastectomy for breast cancer. Methods A retrospective analysis was conducted on 60 female patients who underwent radical mastectomy and required chest wall radiotherapy at the hospital between January 2023 and March 2025. The Pinnacle³ 9.10 radiotherapy planning system （TPS） was utilized to design two VMAT dual semi-arc radiotherapy plans for each patient， with a prescribed target dose of 50 Gy delivered in 2 Gy fractions over 25 sessions. In Plan 1， a Bolus was applied and optimized during the first 15 fractions， and subsequently removed for the remaining 10 fractions without re-optimization. The sub-field configuration and dose weighting from the initial optimization were retained， and only dose recalculations were performed. The final treatment plan combined both the Bolus-included and Bolus-excluded phases. In contrast， Plan 2 involved the application and optimization of Bolus during the first 15 fractions， followed by its removal and re-optimization of the plan for the last 10 fractions. The two optimized plans were then combined for the overall treatment delivery. Data from the two plan groups were analyzed using a paired sample t-test with SPSS 29.0 software. Results There was a statistically significant difference （P < 0.05） in skin D_mean， V_52.5， and V₅₅； heart D_mean， V₅， V₃₀， and V₄₀； affected lung D_mean， V₅， and V₂₀； PRVcord D_mean and D_max； healthy breast D_mean， V₅， and V₁₀； affected humeral head D_mean and V₃₀； as well as PTV D_mean， V₅₀， V₅₅， D_2%， D_98%， CI， and MU. Moreover， the dose distribution on the target layer and the DVH curves showed marked differences. However， no statistically significant difference was observed in PTV HI （P = 0.125）. Conclusion The combination of the two optimized plans， consisting of 15 fractions with bolus and 10 fractions without bolus， more accurately reflects the dose distribution within the planned target area and organs at risk， thereby providing enhanced protection for the patient's chest wall skin.

Key words: blous, postmastectomy, chest wall, skin dose

CLC Number:

R737.9

Zuohuai HU,Jiandong FU,Xiaofang LI,Xinyue YAO,Bin ZHAO,Shu YAN,Sisi. HE. The impact of different bolus application methods on chest wall skin dose after radical mastectomy for breast cancer[J]. The Journal of Practical Medicine, 2025, 41(14): 2138-2142.

Figures/Tables 4

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References 21

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项目	Plan1	Plan2	t值	P值
V₅₀/%	97.660 ± 0.853	96.513 ± 0.988	9.193	< 0.001
V₅₅/%	3.169 ± 3.106	0.648 ± 0.834	6.124	< 0.001
D_2%/cGy	5 503.200 ± 76.200	5 401.350 ± 81.428	14.805	< 0.001
D_98%/cGy	4 983.150 ± 45.131	4 928.050 ± 52.469	9.931	< 0.001
Dmean/cGy	5 284.270 ± 40.732	5 210.918 ± 33.200	16.399	< 0.001
CI	0.757 ± 0.496	0.794 ± 0.450	-7.580	< 0.001
HI	0.110 ± 0.143	0.074 ± 0.010	1.570	0.125
MU	600.883 ± 52.505	576.148 ± 48.850	7.347	< 0.001

OARs	Plan1	Plan2	T值	P值
皮肤
Dmean/cGy	4 637.885 ± 125.539	4 609.655 ± 113.957	5.356	< 0.001
V_52.5/%	8.080 ± 4.673	5.381 ± 4.020	9.825	< 0.001
V₅₅/%	0.489 ± 1.273	0.157 ± 0.350	2.135	< 0.05
心脏
Dmean/cGy	440.978 ± 103.056	417.678 ± 94.365	7.565	< 0.001
V₅/%	26.324 ± 12.259	23.969 ± 11.205	5.097	< 0.001
V₃₀/%	2.351 ± 2.434	2.078 ± 2.228	5.939	< 0.001
V₄₀/%	0.904 ± 1.307	0.725 ± 1.121	4.202	< 0.001
肺
Dmean/cGy	1 323.288 ± 159.286	1 297.565 ± 151.869	7.970	< 0.001
V₅/%	51.619 ± 1.950	49.398 ± 2.481	7.019	< 0.001
V₂₀/%	23.946 ± 3.683	23.357 ± 3.596	2.892	< 0.01
脊髓外扩
Dmea/cGy	280.100 ± 130.871	301.338 ± 134.977	-9.014	< 0.001
Dmax/cGy	2 112.773 ± 916.213	2 194.255 ± 906.849	-10.012	< 0.001
乳房
Dmean/cGy	301.310 ± 96.399	318.600 ± 96.996	-8.275	< 0.001
V₅/%	14.437 ± 10.061	15.849 ± 11.116	-4.983	< 0.001
V₁₀/%	1.193 ± 2.019	0.933 ± 1.644	3.174	< 0.01
肱骨头
Dmean/cGy	1 834.523 ± 563.166	1 764.893 ± 564.591	7.329	< 0.001
V₃₀/%	13.324 ± 11.292	10.990 ± 10.892	5.510	< 0.001

The impact of different bolus application methods on chest wall skin dose after radical mastectomy for breast cancer

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