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Dahn HM, Boersma LJ, de Ruysscher D, Meattini I, Offersen BV, Pignol JP, Aristei C, Belkacemi Y, Benjamin D, Bese N, Coles CE, Franco P, Ho A, Hol S, Jagsi R, Kirby AM, Marrazzo L, Marta GN, Moran MS, Nichol AM, Nissen HD, Strnad V, Zissiadis YE, Poortmans P, Kaidar-Person O. The use of bolus in postmastectomy radiation therapy for breast cancer: A systematic review. Crit Rev Oncol Hematol 2021; 163:103391. [PMID: 34102286 DOI: 10.1016/j.critrevonc.2021.103391] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/21/2022] Open
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.
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Affiliation(s)
- Hannah M Dahn
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada.
| | - Liesbeth J Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - Dirk de Ruysscher
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Birgitte V Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.
| | | | - Cynthia Aristei
- Radiation Oncology Section Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy.
| | - Yazid Belkacemi
- Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France; INSERM Unit 955, Team 21. IMRB, Creteil, France.
| | - Dori Benjamin
- Department of Physics, Radiation Oncology, Sheba medical Center, Ramat Gan, Israel.
| | - Nuran Bese
- Department of Clinical Senology, Research Institute of Senology Acibadem, Istanbul, Turkey.
| | | | - Pierfrancesco Franco
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy; Department of Radiation Oncology, University Hospital "Maggiore della Carità, Novara, Italy.
| | - Alice Ho
- Harvard Medical School, Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
| | - Sandra Hol
- Instituut Verbeeten, Tilburg, the Netherlands.
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.
| | - Anna M Kirby
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK.
| | - Livia Marrazzo
- Medical Physics Unit, Careggi University Hospital, Florence, Italy.
| | - Gustavo N Marta
- Department of Radiation Oncology - Hospital Sírio-Libanês, São Paulo, Brazil.
| | | | - Alan M Nichol
- Department of Radiation Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada.
| | | | - Vratislav Strnad
- Dept. of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany.
| | | | - Philip Poortmans
- Iridium Netwerk and University of Antwerp, Wilrijk Antwerp, Belgium.
| | - Orit Kaidar-Person
- Sheba Medical Center, Ramat Gan, Israel GROW-School for Oncology and Developmental Biology or GROW (Maastro), Maastricht University, Maastricht, the Netherlands; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Kaidar-Person O, Offersen BV, Boersma LJ, de Ruysscher D, Tramm T, Kühn T, Gentilini O, Mátrai Z, Poortmans P. A multidisciplinary view of mastectomy and breast reconstruction: Understanding the challenges. Breast 2021; 56:42-52. [PMID: 33610903 PMCID: PMC7905468 DOI: 10.1016/j.breast.2021.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 12/18/2022] Open
Abstract
The current review paper was written in collaboration with breast cancer surgeons from the European Breast Cancer Research Association of Surgical Trialists (EUBREAST), a breast pathologist from the Danish Breast Cancer Group (DBCG), and representatives from the European SocieTy for Radiotherapy & Oncology (ESTRO) breast cancer course. Herein we summarize the different mastectomies and reconstruction procedures and define high-risk anatomical areas for breast cancer recurrences, to further specify the challenges in the surgical procedure, histopathological evaluation, and target volumes in case of postmastectomy irradiation, as recommended by the ESTRO guidelines according to the surgical procedure. The paper has original figures and illustrations for all disciplines for in-depth understanding of the differences between the procedures. Mastectomy techniques and reconstruction evolved to improve cosmetic outcomes. Different techniques maybe associated with different amount of residual breast tissue. More data is needed to estimate who are the patients at risk for residual disease or recurrence. Multidisciplinary work needed to individualise treatment for optimal oncological outcomes while maintaining the significant improvements in achieving better cosmesis for these patients.
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Affiliation(s)
- Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, At Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; GROW-School for Oncology and Developmental Biology (Maastro), Maastricht University, Maastricht, the Netherlands.
| | - Birgitte V Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - Liesbeth J Boersma
- GROW-School for Oncology and Developmental Biology (Maastro), Maastricht University, Maastricht, the Netherlands; Department of Radiation Oncology (Maastro), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Dirk de Ruysscher
- GROW-School for Oncology and Developmental Biology (Maastro), Maastricht University, Maastricht, the Netherlands; Department of Radiation Oncology (Maastro), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Trine Tramm
- Department of Pathology, Aarhus University Hospital, Denmark
| | - Thorsten Kühn
- Department of Gynaecology and Obstetrics, Interdisciplinary Breast Center, Klinikum Esslingen, Germany
| | - Oreste Gentilini
- Breast Surgery Unit, San Raffaele University Hospital, Milan, Italy
| | - Zoltán Mátrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, 1122, Budapest, Ráth György U 7, Hungary
| | - Philip Poortmans
- Iridium Kankernetwerk, 2610, Wilrijk-Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, 2610, Wilrijk-Antwerp, Belgium
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