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A bolus is a kind of tissue equivalent material used in radiotherapy for treating superficial lesions. Despite the availability of various commercial boluses, it is hard for them to form full contact with the irregular surface of patients’ skin, such as the scalp, nose, and ear, resulting in air gaps and leading to a discrepancy between the delivered dose and planned dose. To solve this problem, we provided a photocurable bioink created from chitosan (CHI) for digital light processing (DLP) three-dimensional (3D) printing the bolus in radiotherapy application. The chitosan-based bioink (CHI–MA) was obtained by a methacrylation process using methacrylic anhydride (MA). Photosensitive crosslinkers with different molecular weights were introduced into the bioink. The photocuring efficiency and mechanical properties of CHI–MA hydrogels can be well modulated by varying the crosslinkers. This CHI–MA bioink allowed us to create complex structures with reliable biocompatibility, good flexibility, and excellent structural stability. Furthermore, the nose bolus processed by 3D printing this bioink proved to be a good fit for the nose model and showed a desirable radiotherapy effect. This suggests that DLP 3D printing of the CHI–MA bioink would be a promising approach to obtain the customized bolus in the application of radiotherapy.

Bolus is a kind of auxiliary device used in radiotherapy for the treatment of superficial lesions such as skin cancer. It is commonly used to increase skin dose and overcome the skin-sparing effect. Despite the availability of various commercial boluses, there is currently no bolus that can form full contact with irregular surface of patients’ skin, and incomplete contact would result in air gaps. The resulting air gaps can reduce the surface radiation dose, leading to a discrepancy between the delivered dose and planned dose. To avoid this limitation, the customized bolus processed by three-dimensional (3D) printing holds tremendous potential for making radiotherapy more efficient than ever before. This review mainly summarized the recent development of polymers used for processing bolus, 3D printing technologies suitable for polymers, and customization of 3D printing bolus. An ideal material for customizing bolus should not only have the feature of 3D printability for customization, but also possess radiotherapy adjuvant performance as well as other multiple compound properties, including tissue equivalence, biocompatibility, antibacterial activity, and antiphlogosis.