Quantitative Effect of Bolus on Skin Dose in Postmastectomy Radiation Therapy

Wong, Gina; Lam, Emily; Bosnic, Sandi; Karam, Irene; Drost, Leah; Yee, Caitlin; Ariello, Krista; Chow, Edward; Wronski, Matt

doi:10.1016/j.jmir.2020.06.006

Cited by 9 publications

(5 citation statements)

References 21 publications

(43 reference statements)

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“…Though the calculation of D Surf by TPS is inaccurate, the precise measurement of D Surf can offer significant information in preventing recurrences near the surface and limiting serious skin toxicity (Sakai et al, 2021;Robar et al, 2018). Gina Wong et al (Wong et al, 2020) found that the TPS calculated mean surface dose without and with 5.0 mm bolus application was 65% and 95% from 3 for nil, 5.0 mm, and 10.0 mm bolus applications are in good agreement with the above-mentioned published literature. The calculated surface doses were found to be within 10% of the measured values in the absence of a bolus.…”

Section: Discussionsupporting

confidence: 65%

Estimation of Surface Dose in the Presence of Unwanted Air Gaps under the Bolus in Postmastectomy Radiation Therapy: A Phantom Dosimetric Study

Lobo

Challapalli

Sourjya

et al. 2022

Asian Pac J Cancer Prev

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Background:The aim of this study is to design and fabricate a thorax phantom with irregularly shaped trapezoidal slots across the left side of the chest wall, allowing for the creation of unwanted air gaps under the bolus. Method: Surface dose (D surf ) measurements were made with Gaf Chromic EBT3 films at air gaps (0.0, 5.0, 10.0 and 15.0 mm) under gel bolus of thickness (5.0 mm & 10.0 mm), for 3DCRT technique (2 and 3 field) with clinical 6 MV photon beam under uniform and non-uniform air gap condition. The obtained values were compared with TPS estimated ones. Results: In the presence of 15.0 mm uniform air gap, the mean estimated and measured D surf values with two and three field techniques decreased by 14.0 % to 15.2% and 14.7% to 17.4% under 5.0 mm and 10.0 mm bolus applications respectively. In presence of non-uniform air gap condition, the effect on D surf was minimal (3 to 3.5%) compared with the uniform air gap condition. Conclusions: Based on the study's findings, it is recommended that when using bolus in clinical radiotherapy applications, special care be taken to avoid unwanted air gaps under the bolus in order to achieve a uniform surface dose across the treatment region, where a customized 3D printed bolus may be a better option.

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Section: Discussionsupporting

confidence: 65%

Estimation of Surface Dose in the Presence of Unwanted Air Gaps under the Bolus in Postmastectomy Radiation Therapy: A Phantom Dosimetric Study

Lobo

Challapalli

Sourjya

et al. 2022

Asian Pac J Cancer Prev

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“…In a previous study by Gong et al, 9 the skin surface dose of thermoplastic elastomer bolus could reach > 90% of the prescribed dose, while in another study by Fiedler et al 23 with a 3 mm polymer-gel type bolus, the skin dose was 94.8%. Wong et al 17 defined the same skin ROI as this study and reported that the D mean could reach 95% of the prescribed dose, and the D max exceeded the prescribed dose by 5% to 6%. Overall, our results were better than those of the studies mentioned above.…”

Section: Discussionmentioning

confidence: 92%

“…Studies have shown that when bolus isn't used, the average SD can be reduced by 20% to 30%. 17 Yang et al 18 proposed that a thickness of 3 mm had the highest CI when studying the use strategy of bolus in PMRT, which could provide a sufficient dose to the chest wall target. Kaidar-Person et al 4 believed that placing a bolus with a thickness of 3 to 5 mm in line with the body contour was conducive to reducing air gaps and ensuring the SD.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Individualized Silicone Rubber Bolus Using Fan Beam Computed Tomography in Postmastectomy Radiotherapy: A Dosimetric Evaluation and Skin Acute Radiation Dermatitis Survey

Chen,

Xu,

Zeng

et al. 2024

Technol Cancer Res Treat

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Objective: To investigate the dosimetric effects of using individualized silicone rubber (SR) bolus on the target area and organs at risk (OARs) during postmastectomy radiotherapy (PMRT), as well as evaluate skin acute radiation dermatitis (ARD). Methods: A retrospective study was performed on 30 patients with breast cancer. Each patient was prepared with an individualized SR bolus of 3 mm thickness. Fan-beam computed tomography (FBCT) was performed at the first and second fractions, and then once a week for a total of 5 times. Dosimetric metrics such as homogeneity index (HI), conformity index (CI), skin dose (SD), and OARs including the heart, lungs, and spinal cord were compared between the original plan and the FBCTs. The acute side effects were recorded. Results: In targets' dosimetric metrics, there were no significant differences in Dmean and V105% between planning computed tomography (CT) and actual treatments ( P > .05), while the differences in D95%, V95%, HI, and CI were statistically significant ( P < .05). In OARs, there were no significant differences between the Dmean, V5, and V20 of the affected lung, V5 of the heart and Dmax of the spinal cord ( P > .05) except the V30 of affected lung, which was slightly lower than the planning CT ( P < .05). In SD, both Dmax and Dmean in actual treatments were increased than plan A, and the difference was statistically significant ( P < .05), while the skin-V20 and skin-V30 has no difference. Among the 30 patients, only one patient had no skin ARD, and 5 patients developed ARD of grade 2, while the remaining 24 patients were grade 1. Conclusion: The OR bolus showed good anastomoses and high interfraction reproducibility with the chest wall, and did not cause deformation during irradiation. It ensured accurate dose delivery of the target and OARs during the treatment, which may increase SD by over 101%. In this study, no cases of grade 3 skin ARD were observed. However, the potential of using OR bolus to reduce grade 1 and 2 skin ARD warrants further investigation with a larger sample size.

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“…Water hyacinth powder is (Eichhornia crassipes) expected to be a new substrate in the manufacture of radiotherapy boluses. The bolus will be analyzed using CT Scan and LINAC to determine the value of Relative Electron Density (RED) and the percentage of surface dose using 6 MV of energy (Wong et al, 2020). This study aimed to was to develop the basic ingredients for making bolus using biopolymers in water hyacinth (Eichhornia crassipes).…”

Section: Introductionmentioning

confidence: 99%

Effect of Bolus Thickness-Based Base Eichhornia crassipes Powder (Water Hyacinth) on Radiotherapy Bolus Homogeneity

Putri Utami,

Kartikasari,

Sugiyanto

et al. 2024

AJHS

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Bolus radiotherapy aims to make the radiation dose more homogeneous, and increase the surface dose to the skin. Exploration of alternative materials for substitute mixtures that are relatively safer is needed to reduce the weaknesses in the use of plasticine mixtures. To develop the basic ingredients for making bolus using biopolymers in water hyacinth (Eichhornia crassipes). This research was conducted using the method of Research and Development. The suitability of the physical characteristics of the bolus (homogeneity judged by CT number; Relative Electron Density is calculated by a formula ?b;% surface dose is obtained from TPS (Treatment Planning System) in the test and the 3 variations of the thickness (0.5 cm, 1.0 cm and 1.5 cm). The feasibility of the bolus product was determined based on the flexibility of the texture and resistance to cold temperatures. Result: Water hyacinth (Eichhornia crassipes) can be used as a reference for alternative bolus materials in radiotherapy due to the response of water hyacinth (Eichhornia crassipes) to radiation Water hyacinth (Eichhornia crassipes-based bolus has same RED (Relative Electron Density) value as soft and solid tissue in all thickness variations and has a surface dose value of ±100% for all thickness variations. Water hyacinth (Eichhornia crassipes) based bolus is homogeneous against radiation and can increase the dose surface so that water hyacinth (Eichhornia crassipes) has benefits and can be used as an alternative bolus material in radiotherapy

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Quantitative Effect of Bolus on Skin Dose in Postmastectomy Radiation Therapy

Cited by 9 publications

References 21 publications

Estimation of Surface Dose in the Presence of Unwanted Air Gaps under the Bolus in Postmastectomy Radiation Therapy: A Phantom Dosimetric Study

Estimation of Surface Dose in the Presence of Unwanted Air Gaps under the Bolus in Postmastectomy Radiation Therapy: A Phantom Dosimetric Study

Analysis of Individualized Silicone Rubber Bolus Using Fan Beam Computed Tomography in Postmastectomy Radiotherapy: A Dosimetric Evaluation and Skin Acute Radiation Dermatitis Survey

Effect of Bolus Thickness-Based Base Eichhornia crassipes Powder (Water Hyacinth) on Radiotherapy Bolus Homogeneity

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