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

Hannah M. Dahn*, Liesbeth J. Boersma, Dirk de Ruysscher, Icro Meattini, Birgitte Offersen, Jean-Philippe Pignol, Cynthia Aristei, Yazid Belkacemi, Dori Benjamin, Nuran Bese, Charlotte E. Coles, Pierfrancesco Franco, Alice Ho, Sandra Hol, Reshma Jagsi, Anna M. Kirby, Livia Marrazzo, Gustavo N. Marta, Meena S. Moran, Alan M. NicholHenrik D. Nissen, Vratislav Strnad, Yvonne E. Zissiadis, Philip Poortmans, Orit Kaidar-Person

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

3 Citations (Web of Science)

Abstract

Purpose: Post mastectomy radiation therapy (PMRT) reduces locoregional recurrence (LRR) and breast cancer mortality for selected patients. Bolus overcomes the skin-sparing effect of external-beam radiotherapy, ensuring adequate dose to superficial regions at risk of local recurrence (LR). This systematic review summarizes the current evidence regarding the impact of bolus on LR and acute toxicity in the setting of PMRT. Results: 27 studies were included. The use of bolus led to higher rates of acute grade 3 radiation dermatitis (pooled rates of 9.6% with bolus vs. 1.2% without). Pooled crude LR rates from thirteen studies (n = 3756) were similar with (3.5%) and without (3.6%) bolus. Conclusions: Bolus may be indicated in cases with a high risk of LR in the skin, but seems not to be necessary for all patients. Further work is needed to define the role of bolus in PMRT.

Original languageEnglish
Article number103391
Number of pages13
JournalCritical Reviews in Oncology/Hematology
Volume163
DOIs
Publication statusPublished - Jul 2021

Keywords

  • breast cancer
  • mastectomy
  • radiation therapy
  • post-mastectomy
  • PMRT
  • bolus
  • tissue compensator
  • CHEST-WALL
  • FOLLOW-UP
  • RADICAL-MASTECTOMY
  • LOCOREGIONAL RECURRENCE
  • COMPLICATION RATES
  • PROTON THERAPY
  • STAGE-I
  • OUTCOMES
  • RADIOTHERAPY
  • RISK

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