The use of bolus in postmastectomy radiation therapy for breast cancer: A systematic review,Critical Reviews in Oncology/Hematology

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The use of bolus in postmastectomy radiation therapy for breast cancer: A systematic review
Critical Reviews in Oncology/Hematology ( IF 5.5 ) Pub Date : 2021-06-05 , DOI: 10.1016/j.critrevonc.2021.103391
Hannah M Dahn ₁ , Liesbeth J Boersma ₂ , Dirk de Ruysscher ₂ , Icro Meattini ₃ , Birgitte V Offersen ₄ , Jean-Philippe Pignol ₁ , Cynthia Aristei ₅ , Yazid Belkacemi ₆ , Dori Benjamin ₇ , Nuran Bese ₈ , Charlotte E Coles ₉ , Pierfrancesco Franco ₁₀ , Alice Ho ₁₁ , Sandra Hol ₁₂ , Reshma Jagsi ₁₃ , Anna M Kirby ₁₄ , Livia Marrazzo ₁₅ , Gustavo N Marta ₁₆ , Meena S Moran ₁₇ , Alan M Nichol ₁₈ , Henrik D Nissen ₁₉ , Vratislav Strnad ₂₀ , Yvonne E Zissiadis ₂₁ , Philip Poortmans ₂₂ , Orit Kaidar-Person ₂₃

Affiliation

Department of Radiation Oncology, Dalhousie University, Halifax, Canada.
Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.
Radiation Oncology Section Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy.
Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France; INSERM Unit 955, Team 21. IMRB, Creteil, France.
Department of Physics, Radiation Oncology, Sheba medical Center, Ramat Gan, Israel.
Department of Clinical Senology, Research Institute of Senology Acibadem, Istanbul, Turkey.
Department of Oncology, University of Cambridge, Cambridge, UK.
Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy; Department of Radiation Oncology, University Hospital "Maggiore della Carità, Novara, Italy.
Harvard Medical School, Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
Instituut Verbeeten, Tilburg, the Netherlands.
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.
Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK.
Medical Physics Unit, Careggi University Hospital, Florence, Italy.
Department of Radiation Oncology - Hospital Sírio-Libanês, São Paulo, Brazil.
Yale School of Medicine, USA.
Department of Radiation Oncology, BC Cancer - Vancouver, Vancouver, BC, Canada.
Department of Oncology, Vejle Hospital, Denmark.
Dept. of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany.
Hollywood Radiation Oncology, GenesisCare, WA, Australia.
Iridium Netwerk and University of Antwerp, Wilrijk Antwerp, Belgium.
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.

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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