The Journal of Practical Medicine >

2025 , Vol. 41 >Issue 14: 2138 - 2142

DOI: https://doi.org/10.3969/j.issn.1006-5725.2025.14.003

Feature Reports：Breast carcinoma

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

  • Zuohuai HU ,
  • Jiandong FU ,
  • Xiaofang LI ,
  • Xinyue YAO ,
  • Bin ZHAO ,
  • Shu YAN ,
  • Sisi. HE
Expand
  • Department of Radiation Oncology，the Second Affiliated Hospital of Zunyi Medical University，Zunyi 563003，Guizhou，China

Received date: 2024-12-11

  Online published: 2025-07-29

Fold

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 Dmean， V52.5， and V55； heart Dmean， V5， V30， and V40； affected lung Dmean， V5， and V20； PRVcord Dmean and Dmax； healthy breast Dmean， V5， and V10； affected humeral head Dmean and V30； as well as PTV Dmean， V50， V55， D2%， D98%， 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

Cite this article

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 . DOI: 10.3969/j.issn.1006-5725.2025.14.003

References

[1] 李智博， 周军 . 超声对乳腺癌腋窝淋巴结状态评估的应用进展［J］. 实用医学杂志， 2020， 36（22）：3161-3165.
[2] CAO W ， CHEN H D ， YU Y W ， et al . Changing profiles of cancer burden worldwide and in China：A secondary analysis of theglobal cancer statistics 2020［J］. Chin Med J（Engl）， 2021， 134（7）：783-791. doi:10.1097/cm9.0000000000001474
[3] 丘雅波， 罗庆， 倪雪菲， 等 . 海南省2014—2018年35~64岁妇女乳腺癌筛查结果分析［J］. 中国热带医学， 2021， 21（11）：1041-1046.
[4] QIU J J ， ZHANG S J ， LV B ， et al . Cardiac dose control and optimization strategy for left breast cancer radiotherapy with non-uniform VMAT technology［J］.Technol Cancer Res Treat， 2021， 20： 15330338211053752. doi:10.1177/15330338211053752
[5] 杨继明， 程杭， 马敏， 等 . 左侧乳腺癌患者根治术后常规调强计划与电子束适形联合调强计划的剂量比较［J］. 中华放射医学与防护杂志， 2022， 42（4）：262-268. doi:10.3760/cma.j.cn112271-20211209-00477
[6] JAGSI R ， RAAD R A ， GOLDBERG S ， et al . Locoregional recurrence rates and prognostic factors for failure in node-negative patients treated with mastectomy： Implications for postmastectomy radiation［J］.Int J Radiat Oncol Biol Phys， 2005， 62（4）：1035-1039. doi:10.1016/j.ijrobp.2004.12.014
[7] MARTIJN H ， CASPERS R J ， WELVAART K ， et al . Locally advanced breast cancer： Radiotherapy alone versus surgery and radiotherapy［J］. Radiother Oncol， 1989， 16（1）：23-29. doi:10.1016/0167-8140(89)90067-4
[8] NICHOL A ， NARINESINGH D ， RAMAN S ， et al . The Effect of Bolus on Local Control for Patients Treated With Mastectomy and Radiation Therapy［J］. Int J Radiat Oncol Biol Phys， 2021， 110（5）： 1360-1369. doi:10.1016/j.ijrobp.2021.01.019
[9] NAKAMURA N ， ARAHIRA S ， ZENDA S ， et al . Post-mastectomy radiation therapy without usage of a bolus may be a reasonable option［J］. J Radiat Res， 2017， 58（1）：66-70. doi:10.1093/jrr/rrw055
[10] SHIBA S ， OKAMOTO M ， KIYOHARA H ， et al . Clinical advantage of chest-wall post-mastectomy radiation therapy without bolus［J］. In Vivo， 2018， 32（4）： 961-965. doi:10.21873/invivo.11335
[11] NUZZO M ， URSINI L A ， PATANI F ， et al . Using the bolus in postmastectomy radiation therapy （PMRT）： A national survey on behalf of the Italian Association of Radiotherapy and Clinical Oncology （AIRO） breast cancer group［J］.Anticancer Res， 2020， 40（11）：6505-6511. doi:10.21873/anticanres.14673
[12] YAP M L ， TIEU M ， SAPPIATZER J ， et al . Outcomes in patients treated with post-mastectomy chest wall radiotherapy without the routine use of bolus［J］.Clin Oncol （R Coll Radiol）， 2018， 30（7）：427-432. doi:10.1016/j.clon.2018.03.005
[13] 中国医师协会放射肿瘤治疗医师分会 . 乳腺癌放射治疗指南（中国医师协会2020 版）［J］. 中华放射肿瘤学杂志， 2021， 30（4）： 321-342.
[14] 杨翠， 杨昭志， 胡伟刚， 等 . 乳腺癌根治术后放疗中不同补偿物使用策略对剂量分布的影响［J］. 中华放射医学与防护杂志， 2023， 43（1）：30-35.
[15] KAIDAR-PERSON O ， DAHN H M ， NICHOL A M ， et al . A delphi study and international consensus recommendations： The use of bolus in the setting of postmastectomy radiation therapy for early breast cancer ［J］. Radiother Oncol， 2021， 164：115-121. doi:10.1016/j.radonc.2021.09.012
[16] DAHN H M ， BOERSMA L J ， DE RUYSSCHER D ， et al . The use of bolus in postmast-ectomy radiation therapy for breast cancer： A systematic review ［J］. Crit Rev Oncol Hematol， 2021， 163： 103391. doi:10.1016/j.critrevonc.2021.103391
[17] 范强， 涂彧， 赵涤非， 等 . 金属氧化物半导体场效应晶体管测量组织补偿胶对乳腺癌胸壁照射皮肤X线表面剂量的影响［J］. 中国现代医药杂志， 2010， 12（8）：9-11.
[18] 胡作怀， 付建东， 陈芳， 等 . 组织补偿膜添加方式引起的放疗剂量差异研究［J］.中华放射肿瘤学杂志， 2016， 25（4）：388-390.
[19] YAP M L ， TIEU M ， SAPPIATZER J ， et al . Outcomes in patients treated with post-mastectomy chest wall radiotherapy without the routine use of bolus［J］. Clin Oncol （R Coll Radiol）， 2018， 30（7）：427-432. doi:10.1016/j.clon.2018.03.005
[20] 田楠楠， 王树超， 常军， 等 . 乳腺癌根治术后组织补偿物对胸壁放疗剂量学影响［J］. 社区医学杂志， 2022， 20（24）：1372-1376.
[21] 方键蓝， 方涌文， 刘镖水， 等 . Catalyst HD 光学体表引导发泡胶固定乳腺癌调强放疗摆位精度的研究［J］. 实用医学杂志， 2022， 38（5）：547-551.
Options
Outlines

/

〈 〉