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Miéville FA, Pitteloud N, Achard V, Lamanna G, Pisaturo O, Tercier PA, Allal AS. Post-mastectomy radiotherapy: Impact of bolus thickness and irradiation technique on skin dose. Z Med Phys 2023:S0939-3889(23)00041-7. [PMID: 37150728 DOI: 10.1016/j.zemedi.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE To determine 10 MV IMRT and VMAT based protocols with a daily bolus targeting a skin dose of 45 Gy in order to replace the 6 MV tangential fields with a 5 mm thick bolus on alternate days method for post-mastectomy radiotherapy. METHOD We measured the mean surface dose along the chest wall PTV as a function of different bolus thicknesses for sliding window IMRT and VMAT plans. We analyzed surface dose profiles and dose homogeneities and compared them to our standard 6 MV strategy. All measurements were performed on a thorax phantom with Gafchromic films while dosimetric plans were computed using the Acuros XB algorithm (Varian). RESULTS We obtained the best compromise between measured surface dose (mean dose and homogeneity) and skin toxicity threshold obtained from the literature using a daily 3 mm thick bolus. Mean surface doses were 91.4 ± 2.8% [85.7% - 95.4%] and 92.2 ± 2.3% [85.6% - 95.2%] of the prescribed dose with IMRT and VMAT techniques, respectively. Our standard 6 MV alternate days 5 mm thick bolus leads to 89.0 ± 3.7% [83.6% - 95.5%]. Mean dose differences between measured and TPS results were < 3.2% for depths as low as 2 mm depth. CONCLUSION 10 MV IMRT-based protocols with a daily 3 mm thick bolus produce a surface dose comparable to the standard 6 MV 5 mm thick bolus on alternate days method but with an improved surface dose homogeneity. This allows for a better control of skin toxicity and target volume coverage.
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Affiliation(s)
- Frédéric A Miéville
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland.
| | - Nicolas Pitteloud
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Vérane Achard
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Giorgio Lamanna
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Olivier Pisaturo
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Pierre-Alain Tercier
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
| | - Abdelkarim S Allal
- Department of Radiation Oncology, Hôpital Fribourgeois, 2-6 Chemin des Pensionnats, 1752 Villars-sur-Glâne, Fribourg, Switzerland
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Guebert A, Roumeliotis M, Wu CHD, Long K, Logie N, Graham T, Gourley A, Craighead P, Sia M, Quirk S. The transition in practice to reduce bolus use in post-mastectomy radiotherapy: A dosimetric study of skin and subcutaneous tissue. Med Dosim 2023; 48:113-117. [PMID: 36907800 DOI: 10.1016/j.meddos.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 03/12/2023]
Abstract
To inform clinical practice for women receiving post-mastectomy radiotherapy (PMRT), this study demonstrates the dosimetric impact of removing daily bolus on skin and subcutaneous tissue. Two planning strategies were used: clinical field-based (n = 30) and volume-based planning (n = 10). The clinical field-based plans were created with bolus and recalculated without bolus for comparison. The volume-based plans were created with bolus to ensure a minimum target coverage of the chest wall PTV and recalculated without bolus. In each scenario, the dose to superficial structures, including skin (3 mm and 5 mm) and subcutaneous tissue (a 2 mm layer, 3 mm deep from surface) were reported. Additionally, the difference in the clinically evaluated dosimetry to skin and subcutaneous tissue in volume-based plans were recalculated using Acuros (AXB) and compared to the Anisotropic Analytical Algorithm (AAA) algorithm. For all treatment planning strategies, chest wall coverage (V90%) was maintained. As expected, superficial structures demonstrate significant loss in coverage. The largest difference observed in the most superficial 3 mm where V90% coverage is reduced from a mean (± standard deviation) of 95.1% (± 2.8) to 18.9% (± 5.6) for clinical field-based treatments with and without bolus, respectively. For volume-based planning, the subcutaneous tissue maintains a V90% of 90.5% (± 7.0) compared to the clinical field-based planning coverage of 84.4% (± 8.0). In all skin and subcutaneous tissue, the AAA algorithm underestimates the volume of the 90% isodose. Removing bolus results in minimal dosimetric differences in the chest wall and significantly lower skin dose while dose to the subcutaneous tissue is maintained. Unless the skin has disease involvement, the most superficial 3 mm is not considered part of the target volume. The continued use of the AAA algorithm is supported for the PMRT setting.
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Affiliation(s)
- Alexandra Guebert
- Department of Physics & Astronomy, University of Calgary, Calgary, AB, Canada
| | - Michael Roumeliotis
- Department of Physics & Astronomy, University of Calgary, Calgary, AB, Canada; Department of Oncology, University of Calgary, Calgary, AB, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada
| | | | - Karen Long
- Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Natalie Logie
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada
| | | | | | - Peter Craighead
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Michael Sia
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Sarah Quirk
- Department of Physics & Astronomy, University of Calgary, Calgary, AB, Canada; Department of Oncology, University of Calgary, Calgary, AB, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada.
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Hosseini FS, Baghani HR, Robatjazi M, Mowlavi AA, Porouhan P. Performance evaluation of buildup bolus during external radiotherapy of mastectomy patients: treatment planning and film dosimetry. Med Biol Eng Comput 2023; 61:435-444. [PMID: 36460872 DOI: 10.1007/s11517-022-02721-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/19/2022] [Indexed: 12/04/2022]
Abstract
A buildup bolus is used during the post-mastectomy radiotherapy (PMRT) to overcome under-dosage issues in the chest wall. The current study is aimed at evaluating the performance of a bolus in dose enhancement through both film dosimetry and treatment planning approaches. Twenty patients were enrolled in current research. The received dose by the skin at the lateral and medial regions of the chest wall in the presence and absence bolus was evaluated. Film dosimetry results showed that the presence of the bolus can averagely increase the skin dose by about 80% (P value < 0.001) and 92% (P value < 0.001) in lateral and medial regions, respectively. No significant difference was observed between the measured and treatment planning system (TPS)-calculated dose values in the presence of bolus. The presence of the bolus can considerably increase the absorbed dose by superficial chest wall regions. The TPS shows a favorable performance in superficial dose calculations in the presence of the buildup bolus. Hosseini et al.: demonstration of implemented research in the current study.
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Affiliation(s)
| | | | - Mostafa Robatjazi
- Medical Physics and Radiological Sciences Department, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Pejman Porouhan
- Radiation Oncology Department, Sabzevar University of Medical Sciences, Sabzevar, Iran
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Gong P, Dai G, Wu X, Wang X, Xie L, Xu S, Zhong R. Application of thermoplastic elastomer (TPE) bolus in postmastectomy radiotherapy. Breast 2022; 66:317-323. [PMID: 36463642 PMCID: PMC9719108 DOI: 10.1016/j.breast.2022.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/10/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To assess the planned dose, in vivo dosimetry, acute skin toxicity, pain, and distress using Thermoplastic Elastomer (TPE) bolus for postmastectomy radiotherapy (PMRT). MATERIAL AND METHODS Thirty-two PMRT patients with TPE bolus (17 patients for 25 fractions, 15 patients for the first 20 fractions) were selected for the study. The acute skin toxicity, pain, and psychological distress were assessed from the first treatment week to the fourth week after the end of treatment. At the first treatment, the MOSFET was used in vivo dosimetry measurement. RESULTS In vivo dosimetry with the bolus, the dose deviation ranged from -6.22% to -1.56% for 5 points. The presence of grade 1 and 2 skin toxicity reached its peak (70.0% and 13.3%) in the sixth week. Two patients (6.6%) with 25 fractions bolus experienced moist desquamation in the fifth and seventh week, with pain score 2 and 3, and interruptions of 3 and 5 days, respectively. The incidence of pain score 1, 2, and 3 peaked in the fifth (33.3%), fourth (33.3%), and seventh (10.0%) week. No patients experienced grade 3 skin toxicity and severe pain. One patient had significant anxiety, and two patients had significant depression. CONCLUSION The TPE bolus can accurately fit skin and improve the surface dose to more than 90%. Twenty fractions with TPE bolus had similar skin toxicity and pain to those without bolus and did not increase patients' distress and clinical workload, compared with the literature's data, which is an alternative to the 3D printing bolus for PMRT.
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Affiliation(s)
- Pan Gong
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Guyu Dai
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Xiaoyu Wu
- Department of Respiratory Critical Care Medicine/Thoracic Surgery, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Xuetao Wang
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Li Xie
- Department of Radiotherapy/Department of Head and Neck Oncology, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Shuni Xu
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China
| | - Renming Zhong
- Radiotherapy Physics and Technology Center, Cancer Center, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, 610041, PR China.
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5
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Kaidar-Person O, Dahn HM, Nichol AM, Boersma LJ, de Ruysscher D, Meattini I, Pignol JP, Aristei C, Belkacemi Y, Benjamin D, Bese N, Coles CE, Franco P, Ho AY, Hol S, Jagsi R, Kirby AM, Marrazzo L, Marta GN, Moran MS, Nissen HD, Strnad V, Zissiadis Y, Poortmans PM, Offersen BV. A Delphi study and International Consensus Recommendations: The use of bolus in the setting of postmastectomy radiation therapy for early breast cancer. Radiother Oncol 2021; 164:115-121. [PMID: 34563607 DOI: 10.1016/j.radonc.2021.09.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 01/01/2023]
Abstract
Bolus serves as a tissue equivalent material that shifts the 95-100% isodose line towards the skin and subcutaneous tissue. The need for bolus for all breast cancer patients planned for postmastectomy radiation therapy (PMRT) has been questioned. The work was initiated by the faculty of the European SocieTy for Radiotherapy & Oncology (ESTRO) breast cancer courses and represents a multidisciplinary international breast cancer expert collaboration to optimize PMRT. Due to the lack of randomised trials evaluating the benefits of bolus, we designed a stepwise project to evaluate the existing evidence about the use of bolus in the setting of PMRT to achieve an international consensus for the indications of bolus in PMRT, based on the Delphi method.
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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.
| | - Hannah M Dahn
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada
| | - Alan M Nichol
- Department of Radiation Oncology, BC Cancer - Vancouver, Vancouver, 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, Azienda Ospedaliero-Universitaria Careggi; Florence, Italy
| | | | - 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, Creteil, France
| | - Dori Benjamin
- Department of Physics, Radiation Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Nuran Bese
- Acibadem Mehmet Ali Aydinlar University, Research Institute of Senology Istanbul, Turkey
| | | | - Pierfrancesco Franco
- Department of Translational Medicine, University of Eastern Piedmont and Department of Radiation Oncology, University Hospital "Maggiore della Carità,", Novara, Italy
| | - Alice Y Ho
- Harvard Medical School, Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA
| | - Sandra Hol
- Instituut Verbeeten, Tilburg, The Netherlands
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, 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
| | | | | | - Vratislav Strnad
- Dept. of Radiation Oncology, University Hospital Erlangen, Germany
| | | | | | - Birgitte V Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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Lobo D, Banerjee S, Srinivas C, Athiyamaan MS, Reddy S, Sunny J, Ravichandran R, Kotian H, Prakash Saxena PU. Surface Dose Measurements in Chest Wall Postmastectomy Radiotherapy to Achieve Optimal Dose Delivery with 6 MV Photon Beam. J Med Phys 2021; 46:324-333. [PMID: 35261503 PMCID: PMC8853458 DOI: 10.4103/jmp.jmp_59_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/23/2021] [Accepted: 07/08/2021] [Indexed: 11/04/2022] Open
Abstract
Aim A tissue-equivalent bolus of sufficient thickness is used to overcome build up effect to the chest wall region of postmastectomy radiotherapy (PMRT) patients with tangential technique till Radiation Therapy Oncology Group (RTOG) Grade 2 (dry desquamation) skin reaction is observed. The aim of this study is to optimize surface dose delivered to chest wall in three-dimensional radiotherapy using EBT3 film. Materials and Methods Measurements were conducted with calibrated EBT3 films with thorax phantom under "open beam, Superflab gel (0.5 cm) and brass bolus conditions to check correlation against TPS planned doses. Eighty-two patients who received 50 Gy in 25# were randomly assigned to Group A (Superflab 0.5 cm gel bolus for first 15 fractions followed by no bolus in remaining 10 fractions), Group B or Group C (Superflab 0.5 cm gel or single layer brass bolus, respectively, till reaching RTOG Grade 2 skin toxicity). Results Phantom measured and TPS calculated surface doses were within - 5.5%, 4.7%, and 8.6% under open beam, 0.5 cm gel, and single layer of brass bolus applications, respectively. The overall surface doses (OSD) were 80.1% ±2.9% (n = 28), 92.6% ±4.6% (n = 28), and 87.4% ±4.7% (n = 26) in Group A, B, and C, respectively. At the end of treatment, 7 out of 28; 13 out of 28; and 9 out of 26 patients developed Grade 2 skin toxicity having the OSD value of 83.0% ±1.6% (n = 7); 93.7% ±3.2% (n = 13); and 89.9% ±5.6% (n = 9) in Groups A, B, and C, respectively. At the 20th-23rd fraction, 2 out of 7; 6 out of 13; and 4 out of 9 patients in Groups A, B, and C developed a Grade 2 skin toxicity, while the remaining patients in each group developed at the end of treatment. Conclusions Our objective to estimate the occurrence of optimal dose limit for bolus applications in PMRT could be achieved using clinical EBT3 film dosimetry. This study ensured correct dose to scar area to protect cosmetic effects. This may also serve as quality assurance on optimal dose delivery for expected local control in these patients.
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Affiliation(s)
- Dilson Lobo
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - Sourjya Banerjee
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - Challapalli Srinivas
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - M S Athiyamaan
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - Shreyas Reddy
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - Johan Sunny
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - Ramamoorthy Ravichandran
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - Himani Kotian
- Department of Community Medicine, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - P U Prakash Saxena
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
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Wang X, Wang X, Xiang Z, Zeng Y, Liu F, Shao B, He T, Ma J, Yu S, Liu L. The Clinical Application of 3D-Printed Boluses in Superficial Tumor Radiotherapy. Front Oncol 2021; 11:698773. [PMID: 34490095 PMCID: PMC8416990 DOI: 10.3389/fonc.2021.698773] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/23/2021] [Indexed: 02/05/2023] Open
Abstract
During the procedure of radiotherapy for superficial tumors, the key to treatment is to ensure that the skin surface receives an adequate radiation dose. However, due to the presence of the built-up effect of high-energy rays, equivalent tissue compensators (boluses) with appropriate thickness should be placed on the skin surface to increase the target radiation dose. Traditional boluses do not usually fit the skin perfectly. Wet gauze is variable in thickness day to day which results in air gaps between the skin and the bolus. These unwanted but avoidable air gaps lead to a decrease of the radiation dose in the target area and can have a poor effect on the outcome. Three-dimensional (3D) printing, a new rising technology named “additive manufacturing” (AM), could create physical models with specific shapes from digital information by using special materials. It has been favored in many fields because of its advantages, including less waste, low-cost, and individualized design. It is not an exception in the field of radiotherapy, personalized boluses made through 3D printing technology also make up for a number of shortcomings of the traditional commercial bolus. Therefore, an increasing number of researchers have tried to use 3D-printed boluses for clinical applications rather than commercial boluses. Here, we review the 3D-printed bolus’s material selection and production process, its clinical applications, and potential radioactive dermatitis. Finally, we discuss some of the challenges that still need to be addressed with the 3D-printed boluses.
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Affiliation(s)
- Xiran Wang
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Xuetao Wang
- Department of Radiotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongzheng Xiang
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanyuan Zeng
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Fang Liu
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Bianfei Shao
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Tao He
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiachun Ma
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Siting Yu
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Liu
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
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Predictive factors associated with radiation dermatitis in breast cancer. Cancer Treat Res Commun 2021; 28:100403. [PMID: 34082363 DOI: 10.1016/j.ctarc.2021.100403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/27/2021] [Accepted: 05/10/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Radiation dermatitis (RD) is a side effect that frequently arises during radiotherapy (RT) in breast cancer patients. The present study investigates possible predictive factors of RD, as well as the use of skin treatments to manage symptoms. METHODS Demographic and treatment characteristics were collected retrospectively, while skin symptoms and treatments were collected prospectively for patients who received adjuvant RT between December 2013 and November 2015. Patients were seen weekly by clinicians throughout treatment, during which a clinician-reported survey was completed on RD symptoms and skin treatments. Possible predictive factors were correlated with skin outcomes through a univariate ordinal logistic regression analysis. RESULTS A total of 1093 patients were included in this analysis. Predictive factors for erythema included dose fractionation (p<0.0001), tissue volume irradiated by tangential fields (p = 0.01), and administration of a boost (p = 0.005). High BMI (≥30 kg/m2) (p = 0.0004) and boost (p = 0.02) were predictive of edema. A dose of 50 Gy/25 (p<0.0001) and a high irradiated tissue volume (p = 0.0001) were predictive of desquamation. A dose of 50 Gy/25 (p = 0.0005) and high BMI (p = 0.02) were predictors of pain. Bolus use was the only factor associated with bleeding (p = 0.02). Patients who developed desquamation were likely to receive corticosteroids/antihistamines (p<0.0001), topical antibiotics/antifungals (p<0.001), and dressings (p<0.0001). CONCLUSION The findings of this study provide evidence of potential predictors of RD and methods of symptom management based on symptom severity. Prevention of RD is needed among high-risk groups, such as patients with a high BMI or receiving a standard fractionation, boost, or bolus.
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9
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Oliver PAK, Monajemi TT. Skin dose in chest wall radiotherapy with bolus: a Monte Carlo study. Phys Med Biol 2020; 65:155016. [PMID: 32442990 DOI: 10.1088/1361-6560/ab95dc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Monte Carlo simulations are used to investigate skin dose resulting from chest wall radiotherapy with bolus. A simple model of a female thorax is developed, which includes a 2 mm-thick skin layer. Two representative 6 MV source models are considered: a tangents source model consisting of a parallel opposed pair of medial and lateral fields and subfields, and an arc source model. Tissue equivalent (TE) boluses (thicknesses of 3, 5 and 10 mm) and brass mesh bolus are considered. Skin dose distributions depend on incident photon obliquity: for tangents, radiation is incident more obliquely, resulting in longer path lengths through the bolus and higher skin dose compared to the arc source model in most cases. However, for thicker TE boluses, attenuation of oblique photons becomes apparent. Brass bolus and 3 mm TE bolus result in similar mean skin dose. This relatively simple computational model allows for consideration of different bolus thicknesses, materials and usage schedules based on desired skin dose and choice of either tangents or an arc beam technique. For example, using a 5 mm TE bolus every second treatment would result in mean skin doses of 89% and 85% for tangents and the arc source model, respectively. The hot spot metric D[Formula: see text] would be 103% and 99%, respectively.
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Affiliation(s)
- P A K Oliver
- Dept. of Medical Physics, Nova Scotia Health Authority, Halifax, B3H 1V7 Canada
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10
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Lobo D, Banerjee S, Srinivas C, Ravichandran R, Putha SK, Prakash Saxena PU, Reddy S, Sunny J. Influence of Air Gap under Bolus in the Dosimetry of a Clinical 6 MV Photon Beam. J Med Phys 2020; 45:175-181. [PMID: 33487930 PMCID: PMC7810143 DOI: 10.4103/jmp.jmp_53_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/16/2020] [Accepted: 08/23/2020] [Indexed: 12/02/2022] Open
Abstract
Aim: In some situations of radiotherapy treatments requiring application of tissue-equivalent bolus material (e.g., gel bolus), due to material's rigid/semi-rigid nature, undesirable air gaps may occur beneath it because of irregularity of body surface. The purpose of this study was to evaluate the dosimetric parameters such as surface dose (Ds), depth of dose maximum (dmax), and depth dose along central axis derived from the percentage depth dose (PDD) curve of a 6 MV clinical photon beam in the presence of air gaps between the gel bolus and the treatment surface. Materials and Methods: A bolus holder was designed to hold the gel bolus sheet to create an air gap between the bolus and the radiation field analyzer's (RFA-300) water surface. PDD curves were taken for field sizes of 5 cm × 5 cm, 10 cm × 10 cm, 15 cm × 15 cm, 20 cm × 20 cm, and 25 cm × 25 cm, with different thicknesses of gel bolus (0.5, 1.0, and 1.5 cm) and air gap (from 0.0 to 3.0 cm), using a compact ionization chamber (CC13) with RFA-300 keeping 100 cm source-to-surface (water) distance. The dosimetric parameters, for example, “Ds,“ “dmax,“ and difference of PDD (maximum air gap vs. nil air gap), were analyzed from the obtained PDD curves. Results: Compared to ideal conditions of full contact of bolus with water surface, it has been found that there is a reduction in “Ds“ ranging from 14.8% to 3.2%, 14.9% to 1.1%, and 12.6% to 0.7% with the increase of field size for 0.5, 1.0, and 1.5 cm thickness of gel boluses, respectively, for maximum air gap. The “dmax“ shows a trend of moving away from the treatment surface, and the maximum shift was observed for smaller field size with thicker bolus and greater air gap. The effect of air gap on PDD is minimal (≤1%) beyond 0.4 cm depth for all bolus thicknesses and field sizes except for 5 cm × 5 cm with 1.5 cm bolus thickness. Conclusions: The measured data can be used to predict the probable effect on therapeutic outcome due to the presence of inevitable air gaps between the bolus and the treatment surface.
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Affiliation(s)
- Dilson Lobo
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - Sourjya Banerjee
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - Challapalli Srinivas
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - Ramamoorthy Ravichandran
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - Suman Kumar Putha
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - P U Prakash Saxena
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - Shreyas Reddy
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
| | - Johan Sunny
- Department of Radiation Oncology, Kasturba Medical College (A Constituent Institution of Manipal Academy of Higher Education), Mangalore, Karnataka, India
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11
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Aras S, Tanzer İO, İkizceli T. Dosimetric Comparison of Superflab and Specially Prepared Bolus Materials Used in Radiotherapy Practice. Eur J Breast Health 2020; 16:167-170. [PMID: 32656515 PMCID: PMC7337918 DOI: 10.5152/ejbh.2020.5041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/18/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study compares standard commercial bolus material (Superflab) to custom prepared silicone dental impression material (CDIM) and play dough material (PDM) with respect to dosimetric properties and applicability by using ion chamber measurement and calculated dose values. MATERIALS AND METHODS The CDIM bolus was prepared by mixing dental impression silicone material with enough water to maintain a density of about 1.0 g/cm3. The prepared bolus material is applied on an RW3 solid phantom by covering 10x10 cm2 area with 0.5-1 cm thickness. Ion chamber measurements were performed separately with and without bolus material application. The setup was scanned in CT and the same procedure was repeated in the TPS using the scan data, in which the Pencil Beam Convolution dose calculation algorithm was used. To compare the effect of bolus material on tissue, the Superflab bolus and CDIM bolus were applied with 1 cm of thickness on postmastectomy scar and dose calculations on TPS were performed. RESULTS After comparison of the dosimetric values for Superflab, CDIM and PDM, we obtained statistically meaningful results between superflab and CDIM. For PDM, the results obtained with TPS and ion chamber measurements indicated that, it is not suitable to use in radiotherapy application due to its material properties. For the simulated skin dose values obtained at five random points on the scar tissue, the comparison of Superflab and CDIM TPS calculation results were not statistically significant. CONCLUSION The CDIM is easy to prepare and apply on irregular mastectomy scar tissue and it prevents formation of air gaps in the application surface. Especially for curved anatomical regions such as scar tissue, inclusion of the bolus material in treatment planning protocol will reduce dose uncertainty in application. It is safe to use CDIM as an alternative to Superflab in radiotherapy application, whereas PDM is not useful in clinical practice due to its material properties.
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Affiliation(s)
- Serhat Aras
- Medical Imaging Programme, University of Health Sciences, İstanbul, Turkey
| | - İhsan Oğuz Tanzer
- Biomedical Technology Programme, University of Health Sciences, İstanbul, Turkey
| | - Türkan İkizceli
- Department of Radiology, University of Health Sciences, Haseki Training and Research Hospital, İstanbul, Turkey
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12
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Radiotherapy after skin-sparing mastectomy with immediate breast reconstruction in intermediate-risk breast cancer. Strahlenther Onkol 2019; 195:949-963. [DOI: 10.1007/s00066-019-01507-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
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13
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Dias AG, Pinto DFS, Borges MF, Pereira MH, Santos JAM, Cunha LT, Lencart J. Optimization of skin dose using in-vivo MOSFET dose measurements in bolus/non-bolus fraction ratio: A VMAT and a 3DCRT study. J Appl Clin Med Phys 2019; 20:63-70. [PMID: 30628154 PMCID: PMC6371019 DOI: 10.1002/acm2.12525] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 11/06/2018] [Accepted: 12/02/2018] [Indexed: 01/16/2023] Open
Abstract
In‐phantom and in‐vivo three dimensional conformal radiation therapy (3DCRT) and volumetric modulated arc therapy (VMAT) skin doses, measured with and without bolus in a female anthropomorphic phantom RANDO and in patients, were compared against treatment planning system calculated values. A thorough characterization of the metal oxide semiconductor field effect transistor measurement system was performed prior to the measurements in phantoms and patients. Patients with clinical indication for postoperative external radiotherapy were selected. Skin dose showed higher values with 3DCRT technique compared with VMAT. The increase in skin dose due to the use of bolus was quantified. It was observed that, in the case of VMAT, the bolus effect on the skin dose was considerable when compared with 3DCRT. From the point of view of treatment time, bolus cost, and positioning reproducibility, the use of bolus in these situations can be optimized.
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Affiliation(s)
- Anabela G Dias
- Medical Physics Department, Portuguese Institute of Oncology (IPO-Porto), Porto, Portugal.,Medical Physics, Radiobiology and Radiation Protection Group, Research Centre, Portuguese Institute of Oncology, Porto (CI-IPO), Portugal
| | - Diana F S Pinto
- Radiotherapy Department, Portuguese Institute of Oncology, Porto, Portugal
| | - Maria F Borges
- Medical Physics Department, Portuguese Institute of Oncology (IPO-Porto), Porto, Portugal
| | - Maria H Pereira
- Radiotherapy Department, Portuguese Institute of Oncology, Porto, Portugal
| | - João A M Santos
- Medical Physics Department, Portuguese Institute of Oncology (IPO-Porto), Porto, Portugal.,Medical Physics, Radiobiology and Radiation Protection Group, Research Centre, Portuguese Institute of Oncology, Porto (CI-IPO), Portugal.,Abel Salazar Institute of Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal
| | - Luís T Cunha
- Medical Physics Department, Portuguese Institute of Oncology (IPO-Porto), Porto, Portugal.,Medical Physics, Radiobiology and Radiation Protection Group, Research Centre, Portuguese Institute of Oncology, Porto (CI-IPO), Portugal
| | - Joana Lencart
- Medical Physics Department, Portuguese Institute of Oncology (IPO-Porto), Porto, Portugal.,Medical Physics, Radiobiology and Radiation Protection Group, Research Centre, Portuguese Institute of Oncology, Porto (CI-IPO), Portugal
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14
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Henke G, Knauer M, Ribi K, Hayoz S, Gérard MA, Ruhstaller T, Zwahlen DR, Muenst S, Ackerknecht M, Hawle H, Fitzal F, Gnant M, Mátrai Z, Ballardini B, Gyr A, Kurzeder C, Weber WP. Tailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (TAXIS): study protocol for a multicenter, randomized phase-III trial. Trials 2018; 19:667. [PMID: 30514362 PMCID: PMC6278139 DOI: 10.1186/s13063-018-3021-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/25/2018] [Indexed: 12/25/2022] Open
Abstract
Background Complete lymph node removal through conventional axillary dissection (ALND) has been standard treatment for breast cancer patients for almost a century. In the 1990s, however, and in parallel with the advent of the sentinel lymph node (SLN) procedure, ALND came under increasing scrutiny due to its association with significant patient morbidity. Several studies have since provided evidence to suggest omission of ALND, often in favor of axillary radiation, in selected clinically node-negative, SLN-positive patients, thus supporting the current trend in clinical practice. Clinically node-positive patients, by contrast, continue to undergo ALND in many cases, if only for the lack of studies re-assessing the indication for ALND in these patients. Hence, there is a need for a clinical trial to evaluate the optimal treatment for clinically node-positive breast cancer patients in terms of surgery and radiotherapy. The TAXIS trial is designed to fill this gap by examining in particular the value of tailored axillary surgery (TAS), a new technique for selectively removing positive lymph nodes. Methods In this international, multicenter, phase-III, non-inferiority, randomized controlled trial (RCT), including 34 study sites from four different countries, we plan to randomize 1500 patients to either receive TAS followed by ALND and regional nodal irradiation excluding the dissected axilla, or receive TAS followed by regional nodal irradiation including the full axilla. All patients undergo adjuvant whole-breast irradiation after breast-conserving surgery and chest-wall irradiation after mastectomy. The main objective of the trial is to test the hypothesis that treatment with TAS and axillary radiotherapy is non-inferior to ALND in terms of disease-free survival of clinically node-positive breast cancer patients in the era of effective systemic therapy and extended regional nodal irradiation. The trial was activated on 31 July 2018 and the first patient was randomized on 7 August 2018. Discussion Designed to test the hypothesis that TAS is non-inferior to ALND in terms of curing patients and preventing recurrences, yet is significantly superior in reducing patient morbidity, this trial may establish a new worldwide treatment standard in breast cancer surgery. If found to be non-inferior to standard treatment, TAS may significantly contribute to reduce morbidity in breast cancer patients by avoiding surgical overtreatment. Trial registration ClinicalTrials.gov, ID: NCT03513614. Registered on 1 May 2018. www.kofam.ch, ID: NCT03513614. Registered on 17 June 2018. EudraCT No.: 2018–000372-14. Electronic supplementary material The online version of this article (10.1186/s13063-018-3021-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Guido Henke
- Department of Radiation Oncology, St. Gallen Cantonal Hospital, Rorschacher Strasse 95, 9007, St.Gallen, Switzerland
| | - Michael Knauer
- Breast Center, St. Gallen Cantonal Hospital, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Karin Ribi
- SAKK Coordinating Center, Effingerstrasse 33, 3008, Bern, Switzerland.,IBCSG Coordinating Center, Effingerstrasse 40, 3008, Bern, Switzerland
| | - Stefanie Hayoz
- SAKK Coordinating Center, Effingerstrasse 33, 3008, Bern, Switzerland
| | | | - Thomas Ruhstaller
- Breast Center, St. Gallen Cantonal Hospital, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Graubünden Cantonal Hospital, Loestrasse 170, 7000, Chur, Switzerland
| | - Simone Muenst
- Institute of Pathology, University Hospital Basel, Schönbeinstrasse 40, 4031, Basel, Switzerland.,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Markus Ackerknecht
- Department of Biomedicine, University Hospital Basel, Hebelstrasse 20, 4031, Basel, Switzerland.,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Hanne Hawle
- SAKK Coordinating Center, Effingerstrasse 33, 3008, Bern, Switzerland
| | - Florian Fitzal
- Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Breast Health Center, Comprehensive Cancer Center Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Michael Gnant
- Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Breast Health Center, Comprehensive Cancer Center Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Zoltan Mátrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Ráth György u. 7-9, 1122, Budapest, Hungary
| | | | - Andreas Gyr
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Christian Kurzeder
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Walter P Weber
- Breast Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland. .,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland.
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15
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Yap M, Tieu M, Sappiatzer J, Panzarella T, Cuartero J, McCready D, Fyles A. Outcomes in Patients Treated with Post-mastectomy Chest Wall Radiotherapy without the Routine Use of Bolus. Clin Oncol (R Coll Radiol) 2018; 30:427-432. [DOI: 10.1016/j.clon.2018.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/18/2018] [Accepted: 02/20/2018] [Indexed: 12/19/2022]
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16
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Das LC, Golden DW, Perevalova E, Wong AC, De Nardo K, Stepaniak C, Joyce DS, McCabe BP, Hasan Y, Chmura SJ, McCall A. A feasibility study of 2-mm bolus for postmastectomy radiation therapy. Pract Radiat Oncol 2017; 7:161-166. [DOI: 10.1016/j.prro.2016.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/14/2016] [Accepted: 10/19/2016] [Indexed: 11/28/2022]
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17
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Park SY, Choi CH, Park JM, Chun M, Han JH, Kim JI. A Patient-Specific Polylactic Acid Bolus Made by a 3D Printer for Breast Cancer Radiation Therapy. PLoS One 2016; 11:e0168063. [PMID: 27930717 PMCID: PMC5145239 DOI: 10.1371/journal.pone.0168063] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/23/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose The aim of this study was to assess the feasibility and advantages of a patient-specific breast bolus made using a 3D printer technique. Methods We used the anthropomorphic female phantom with breast attachments, which volumes are 200, 300, 400, 500 and 650 cc. We simulated the treatment for a right breast patient using parallel opposed tangential fields. Treatment plans were used to investigate the effect of unwanted air gaps under bolus on the dose distribution of the whole breast. The commercial Super-Flex bolus and 3D-printed polylactic acid (PLA) bolus were applied to investigate the skin dose of the breast with the MOSFET measurement. Two boluses of 3 and 5 mm thicknesses were selected. Results There was a good agreement between the dose distribution for a virtual bolus generated by the TPS and PLA bolus. The difference in dose distribution between the virtual bolus and Super-Flex bolus was significant within the bolus and breast due to unwanted air gaps. The average differences between calculated and measured doses in a 200 and 300 cc with PLA bolus were not significant, which were -0.7% and -0.6% for 3mm, and -1.1% and -1.1% for 5 mm, respectively. With the Super-Flex bolus, however, significant dose differences were observed (-5.1% and -3.2% for 3mm, and -6.3% and -4.2% for 5 mm). Conclusion The 3D-printed solid bolus can reduce the uncertainty of the daily setup and help to overcome the dose discrepancy by unwanted air gaps in the breast cancer radiation therapy.
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Affiliation(s)
- So-Yeon Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Heon Choi
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Center for Convergence Research on Robotics, Advance Institutes of Convergence Technology, Suwon, Republic of Korea
| | - MinSoo Chun
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hye Han
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-in Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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18
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Turner JY, Zeniou A, Williams A, Jyothirmayi R. Technique and outcome of post-mastectomy adjuvant chest wall radiotherapy-the role of tissue-equivalent bolus in reducing risk of local recurrence. Br J Radiol 2016; 89:20160060. [PMID: 27251295 DOI: 10.1259/bjr.20160060] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: Adjuvant chest wall radiotherapy is used in patients with high-risk histological features post-mastectomy to reduce the risk of locoregional recurrence. Treatment can be given with or without a tissue-equivalent bolus to increase skin surface dose. The additional benefit of using a bolus remains unclear; however, it is known to be associated with a higher incidence of skin toxicity. This study compared chest wall recurrence and skin toxicity in patients treated with and without a bolus. METHODS: This retrospective cohort study reviewed 314 consecutive patients who received chest wall radiotherapy between 2005 and 2010. Data were collected on histological, demographic and treatment parameters and on the incidence and grade of acute skin reactions. Treatment outcomes analyzed included chest wall recurrence, disease-free survival and overall survival (OS). RESULTS: 101 patients received treatment with a bolus; 213 patients received treatment without a bolus. A significantly higher incidence of acute skin toxicity was seen in the bolus treatment group (p = 0.002). One patient treated with a bolus developed chest wall recurrence compared with four patients treated without a bolus. No statistically significant difference could be shown between the two groups. 66 (21%) patients had metastatic relapse. Median time to relapse was 29.5 months and OS was 76% in both treatment groups. CONCLUSION: No statistically significant difference in chest wall recurrence can be demonstrated between patients treated with and without a bolus. ADVANCES IN KNOWLEDGE: This study is consistent with limited previous literature and invites further evaluation of the role of a bolus in post-mastectomy chest wall radiotherapy, especially considering the increased toxicity that the use of a bolus generates.
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Affiliation(s)
| | - Anthi Zeniou
- Kent Oncology Centre, Maidstone Hospital, Maidstone, England, UK
| | - Amanda Williams
- Kent Oncology Centre, Maidstone Hospital, Maidstone, England, UK
| | - Rema Jyothirmayi
- Kent Oncology Centre, Maidstone Hospital, Maidstone, England, UK
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19
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In vivo skin dose measurement in breast conformal radiotherapy. Contemp Oncol (Pozn) 2016; 20:137-40. [PMID: 27358592 PMCID: PMC4925725 DOI: 10.5114/wo.2015.54396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 08/11/2015] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY Accurate skin dose assessment is necessary during breast radiotherapy to assure that the skin dose is below the tolerance level and is sufficient to prevent tumour recurrence. The aim of the current study is to measure the skin dose and to evaluate the geometrical/anatomical parameters that affect it. MATERIAL AND METHODS Forty patients were simulated by TIGRT treatment planning system and treated with two tangential fields of 6 MV photon beam. Wedge filters were used to homogenise dose distribution for 11 patients. Skin dose was measured by thermoluminescent dosimeters (TLD-100) and the effects of beam incident angle, thickness of irradiated region, and beam entry separation on the skin dose were analysed. RESULTS Average skin dose in treatment course of 50 Gy to the clinical target volume (CTV) was 36.65 Gy. The corresponding dose values for patients who were treated with and without wedge filter were 35.65 and 37.20 Gy, respectively. It was determined that the beam angle affected the average skin dose while the thickness of the irradiated region and the beam entry separation did not affect dose. Since the skin dose measured in this study was lower than the amount required to prevent tumour recurrence, application of bolus material in part of the treatment course is suggested for post-mastectomy advanced breast radiotherapy. It is more important when wedge filters are applied to homogenize dose distribution.
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20
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Mayadev J, Einck J, Elson S, Rugo H, Hwang S, Bold R, Daroui P, McCloskey S, Yashar C, Kim D, Fowble B. Practice Patterns in the Delivery of Radiation Therapy After Mastectomy Among the University of California Athena Breast Health Network. Clin Breast Cancer 2015; 15:43-7. [DOI: 10.1016/j.clbc.2014.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/09/2014] [Accepted: 07/11/2014] [Indexed: 11/24/2022]
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21
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Mayadev J, Fish K, Valicenti R, West D, Chen A, Martinez S, Phillips T. Utilization and impact of a postmastectomy radiation boost for invasive breast cancer. Pract Radiat Oncol 2014; 4:e269-78. [DOI: 10.1016/j.prro.2014.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/14/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
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22
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Ordonez-Sanz C, Bowles S, Hirst A, MacDougall ND. A single plan solution to chest wall radiotherapy with bolus? Br J Radiol 2014; 87:20140035. [PMID: 24646288 DOI: 10.1259/bjr.20140035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Radiotherapy treatments of post-mastectomy chest walls are complex, requiring treatment close to skin, necessitating bolus use. Commonly used 5- and 10-mm-thick boluses develop full skin dose, needing removal for the latter half of treatment and requiring two treatment plans to be generated. Can a thinner bolus be used for all treatment fractions, requiring only one plan? METHODS Investigation of doses received using (A) a half-time 10-mm-thick Vaseline® bolus (current situation); (B) a brass mesh (Whiting & Davis, Attleboro Falls, MA) and (C) 3- and 5-mm Superflab™ (Mick Radio-Nuclear Instruments, Mount Vernon, NY) for 6 and 15 MV. Dosimetric measurements in Barts WT1 solid water and an anthropomorphic phantom, using ionization chambers and thermoluminescent dosemeters, were used to study the effect of different bolus regimes on the photon depth-dose curves (DDCs) and skin doses. RESULTS Measured skin doses for the current 10-mm-thick Vaseline bolus, brass mesh and 3-mm bolus were compared (5 mm bolus has been rejected). The brass mesh has the least effect on the DDC, with changes <0.7% for depths greater than dmax. Brass mesh conforms superiorly to skin surfaces. Measurements on an anthropomorphic phantom demonstrate an increased skin dose compared with our current treatment protocol. CONCLUSION Brass mesh has the smallest effect on the DDC, whilst sufficiently increasing surface dose. It can be removed at any fraction, based on a clinical decision, without the need for generating a new plan. Treating with one plan significantly reduces planning times. ADVANCES IN KNOWLEDGE Quantification of skin doses required and achieved from wax-on/wax-off treatment compared with alternative available breast boluses.
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Affiliation(s)
- C Ordonez-Sanz
- Radiotherapy Physics, St Bartholomew's Hospital, London, UK
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Esmaeeli AD, Mahdavi SR, Pouladian M, Monfared AS, Bagheri S. Improvement of dose distribution in breast radiotherapy using a reversible transverse magnetic field Linac-MR unit. Med Phys 2013; 41:011709. [DOI: 10.1118/1.4845175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Fischbach M, Hälg RA, Hartmann M, Besserer J, Gruber G, Schneider U. Measurement of skin and target dose in post-mastectomy radiotherapy using 4 and 6 MV photon beams. Radiat Oncol 2013; 8:270. [PMID: 24238366 PMCID: PMC3842796 DOI: 10.1186/1748-717x-8-270] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/11/2013] [Indexed: 11/10/2022] Open
Abstract
Background For patients with high risk breast cancer and mastectomy, radiotherapy is the treatment of choice to improve survival and local control. Target dose is mainly limited due to skin reactions. The feasibility of using 4 MV beams for chest wall treatment was studied and compared to standard 6 MV bolus radiotherapy. Methods Post-mastectomy IMRT was planned on an Alderson-phantom using 4 and 6 MV photon beams without/with a 0.5 cm thick bolus. Dose was measured using TLDs placed at 8 locations in 1 and 3 mm depth to represent skin and superficial target dose, respectively. Results 4 MV and 6 MV beams with bolus perform equally regarding target coverage. The minimum and mean superficial target dose for the 6 MV and 4 MV were 93.0% and 94.7%, and 93.1% and 94.4%, respectively. Regarding skin dose the 4 MV photon beam was advantageous. The minimum and mean skin dose for the 6 MV and 4 MV was 76.7% and 81.6%, and 69.4% and 72.9%, respectively. The TPS was able to predict dose in the build-up region with a precision of around 5%. Conclusions The use of 4 MV photon beams are a good alternative for treating the thoracic wall without the need to place a bolus on the patient. The main limitation of 4 MV beams is the limited dose rate.
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Affiliation(s)
| | | | | | | | | | - Uwe Schneider
- Medical Physics, Radiotherapy Hirslanden, Witellikerstrasse 40, Zürich, CH-8032, Switzerland.
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Chan MF, Chiu-Tsao ST, Li J, Schupak K, Parhar P, Burman C. Confirmation of Skin Doses Resulting from Bolus Effect of Intervening Alpha-cradle and Carbon Fiber Couch in Radiotherapy. Technol Cancer Res Treat 2012; 11:571-81. [PMID: 22712603 DOI: 10.7785/tcrt.2012.500269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In this study, we verified the treatment planning calculations of skin doses with the incorporation of the bolus effect due to the intervening alpha-cradle (AC) and carbon fiber couch (CFC) using radiochromic EBT2 films. A polystyrene phantom (25 × 25 × 15 cm3) with six EBT2 films separated by polystyrene slabs, at depths of 0, 0.1, 0.2, 0.5, 1, 1.4 cm, was positioned above an AC, which was ~1 cm thick. The phantom and AC assembly were CT scanned and the CT-images were transferred to the treatment planning system (TPS) for calculations in three scenarios: (A) ignoring AC and CFC, (B) accounting for AC only, (C) accounting for both AC and CFC. A single posterior 10 × 10 cm2 field, a pair of posterior-oblique 10 × 10 cm2 fields, and a posterior IMRT field (6 MV photons from a Varian Trilogy linac) were planned. For each radiation field configuration, the same MU were used in all three scenarios in the TPS. Each plan for scenario C was delivered to expose a stack of EBT2 films in the phantom through AC and CFC. In addition, in vivo EBT2 film measurement on a lung cancer patient immobilized with AC undergoing IMRT was also included in this study. Point doses and planar distributions generated from the TPS for the three scenarios were compared with the data from the EBT2 film measurements. For all the field arrangements, the EBT2 film data including the in vivo measurement agreed with the doses calculated for scenario (C), within the uncertainty of the EBT2 measurements (~4%). For the single posterior field (a pair of posterior-oblique fields), the TPS generated doses were lower than the EBT2 doses by 34%, 33%, 31%, 13% (34%, 31%, 31%, 11%) for scenario A and by 27%, 25%, 22%, 8% (25%, 21%, 21%, 6%) for scenario B at the depths of 0, 0.1, 0.2, 0.5 cm, respectively. For the IMRT field, the 2D dose distributions at each depth calculated in scenario C agree with those measured data. When comparing the central axis doses for the IMRT field, we found the TPS generated doses for scenario A (B) were lower than the EBT2 data by 35%, 34%, 31%, 16% (29%, 26%, 23%, 10%) at the depths of 0, 0.1, 0.2, 0.5 cm, respectively. There were no significant differences for the depths of 1.0 and 1.4 cm for all the radiation fields studied. TPS calculation of doses in the skin layers accounting for AC and CFC was verified by EBT2 film data. Ignoring the presence of AC and/or CFC in TPS calculation would significantly underestimate the doses in the skin layers. For the clinicians, as more hypofractionated regimens and stereotactic regimens are being used, this information will be useful to avoid potential serious skin toxicities, and also assist in clinical decisions and report these doses accurately to relevant clinical trials/cooperative groups, such as RTOG.
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Affiliation(s)
- Maria F. Chan
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 136 Mountain View Blvd., Basking Ridge, NJ 07920, USA
| | | | - Jingdong Li
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 136 Mountain View Blvd., Basking Ridge, NJ 07920, USA
| | - Karen Schupak
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 136 Mountain View Blvd., Basking Ridge, NJ 07920, USA
| | - Preeti Parhar
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 136 Mountain View Blvd., Basking Ridge, NJ 07920, USA
| | - Chandra Burman
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 136 Mountain View Blvd., Basking Ridge, NJ 07920, USA
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Does the left hand know what the right hand is doing? What plastic surgeons need to know about radiation therapy techniques. Plast Reconstr Surg 2012; 130:772e-773e. [PMID: 23096658 DOI: 10.1097/prs.0b013e318267da92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Healy E, Anderson S, Cui J, Beckett L, Chen AM, Perks J, Stern R, Mayadev J. Skin dose effects of postmastectomy chest wall radiation therapy using brass mesh as an alternative to tissue equivalent bolus. Pract Radiat Oncol 2012; 3:e45-53. [PMID: 24674320 DOI: 10.1016/j.prro.2012.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 05/25/2012] [Accepted: 05/29/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The use of brass mesh as a bolus is relatively uncommon in postmastectomy chest wall radiation therapy (PMRT). This study aimed to characterize the skin dose effects of using 2-mm fine brass mesh as an alternative to the traditional tissue-equivalent bolus during chest wall PMRT. METHODS AND MATERIALS Data were collected from patients who received PMRT using brass mesh at the University of California Davis Department of Radiation Oncology between January 2008 and June 2011. Several patient characteristics including age, body habitus, and ethnicity were analyzed along with several disease and treatment characteristics to determine whether or not they had an impact on the skin reaction observed during radiation treatment. Additionally, in vivo surface dose measurements were obtained for 16 of the 48 patients (33%). RESULTS Forty-eight female patients aged 28-83 received PMRT using brass mesh. As expected, the severity of skin toxicity increased with subsequent doses of radiation with all patients beginning treatment with no skin reaction (National Cancer Institute scores [NCIS] = 0) and the majority of patients completing treatment with either faint to moderate erythema (n = 19, 40%, NCIS = 1) or moderate to brisk erythema (n = 23, 48%, NCIS = 2). In vivo dosimetry analysis revealed surface doses between 81% and 122% of the prescribed dose, with an average of 99% of the prescribed radiation dose and standard deviation of 10% being delivered. CONCLUSIONS For postmastectomy chest wall radiation therapy, brass mesh is an effective alternative to tissue-equivalent bolus. The brass mesh achieved moderate erythema in the majority of patients at the end of treatment and the surface dose was validated using in vivo dosimetry.
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Affiliation(s)
- Erin Healy
- University of California, Davis, Sacramento, California
| | - Shawnee Anderson
- Department of Mathematics, California State University, Sacramento, California
| | - Jing Cui
- Department of Radiation Oncology, University of California, Davis, Sacramento, California
| | - Laurel Beckett
- Department of Biostatistics, University of California, Davis, Sacramento, California
| | - Allen M Chen
- Department of Radiation Oncology, University of California, Davis, Sacramento, California
| | - Julian Perks
- Department of Radiation Oncology, University of California, Davis, Sacramento, California
| | - Robin Stern
- Department of Radiation Oncology, University of California, Davis, Sacramento, California
| | - Jyoti Mayadev
- Department of Radiation Oncology, University of California, Davis, Sacramento, California.
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Rong Y, Yadav P, Welsh JS, Fahner T, Paliwal B. Postmastectomy radiotherapy with integrated scar boost using helical tomotherapy. Med Dosim 2012; 37:233-9. [PMID: 22365416 DOI: 10.1016/j.meddos.2011.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 06/14/2011] [Accepted: 09/06/2011] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to evaluate helical tomotherapy dosimetry in postmastectomy patients undergoing treatment for chest wall and positive nodal regions with simultaneous integrated boost (SIB) in the scar region using strip bolus. Six postmastectomy patients were scanned with a 5-mm-thick strip bolus covering the scar planning target volume (PTV) plus 2-cm margin. For all 6 cases, the chest wall received a total cumulative dose of 49.3-50.4 Gy with daily fraction size of 1.7-2.0 Gy. Total dose to the scar PTV was prescribed to 58.0-60.2 Gy at 2.0-2.5 Gy per fraction. The supraclavicular PTV and mammary nodal PTV received 1.7-1.9 dose per fraction. Two plans (with and without bolus) were generated for all 6 cases. To generate no-bolus plans, strip bolus was contoured and overrode to air density before planning. The setup reproducibility and delivered dose accuracy were evaluated for all 6 cases. Dose-volume histograms were used to evaluate dose-volume coverage of targets and critical structures. We observed reduced air cavities with the strip bolus setup compared with what we normally see with the full bolus. The thermoluminescence dosimeters (TLD) in vivo dosimetry confirmed accurate dose delivery beneath the bolus. The verification plans performed on the first day megavoltage computed tomography (MVCT) image verified that the daily setup and overall dose delivery was within 2% accuracy compared with the planned dose. The hotspot of the scar PTV in no-bolus plans was 111.4% of the prescribed dose averaged over 6 cases compared with 106.6% with strip bolus. With a strip bolus only covering the postmastectomy scar region, we observed increased dose uniformity to the scar PTV, higher setup reproducibility, and accurate dose delivered beneath the bolus. This study demonstrates the feasibility of using a strip bolus over the scar using tomotherapy for SIB dosimetry in postmastectomy treatments.
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Affiliation(s)
- Yi Rong
- Department of Human Oncology, University of Wisconsin, Madison, Madison, WI, USA.
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Chan MF, Zhang Q, Li J, Parhar P, Schupak K, Burman C. The Verification of iPlan Commissioning by Radiochromic EBT2 Films. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ijmpcero.2012.11001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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