Do you always use a bolus when treating with postmastectomy radiotherapy?

I trained at a place where use of a bolus for chest wall irradiation PMRT was standard practice, but this is not so at my practice right now. Assuming negative surgical margins, do you think it is necessary to ensure 100% dose to the skin surface, or perhaps coverage of "lymphatic tracks" there is not essential? Is there data to support use of a bolus as standard practice?

Answer from: Radiation Oncologist at Community Practice

It's important to note that today's PMRT patient (with her skin-sparing surgery and her tissue expanders and her small primary with just two nodes) is not the typical neglected/advanced ulcerated mess of yesteryear. I reserve bolus only for patients with high-risk for skin involvement (inflamm...

Answer from: Radiation Oncologist at Academic Institution

Despite dogmatic teachings (of which there are many, including the options in the poll), I was not convinced that there was any oncologic need for bolus use in PMRT in the absence of skin involvement, regardless of presence or absence of reconstruction. Recent publications and presentations have onl...

Answer from: Radiation Oncologist at Academic Institution

I am not aware of any high-quality evidence to define the optimal bolusing schedule. There is considerable variation in use of bolus from center to center. In our practice, we use 3 mm on bolus on the chest wall fields every other day for the first 2 weeks of treatment (i.e. we bolus 5 of 10 fractio...

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Radiation Oncologist at Rush University Medical Center
Most local recurrences that I have seen are at the...

Radiation Oncologist at Prairie Lakes Healthcare System
Great question.

Answer from: Radiation Oncologist at Community Practice

Vargo and Beriwal, PMID 26383675The above reference shows sites of chest wall relapse after mastectomy and this is the rationale for us to use bolus until a grade 2 reaction develops.For inflammatory cancer or skin involvement, we try to use bolus for the entire course, if feasible.

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Radiation Oncologist at Bon Secours Saint Francis Medical Center
Has this publication changed this group's approach...

Radiation Oncologist at Lake Huron Medical Center
I feel like it should, or at the very least, convi...

Radiation Oncologist at Varian Medical Systems/Allegheny health network
I have scaled down for intermediate risk patients ...

Radiation Oncologist at Jacob E Locke MD PA
What is the -actual- surface dose on the patient u...

Answer from: Radiation Oncologist at Academic Institution

Do we need to reassess our targets? Why do we treat the chest wall? Most recurrences are in the skin or subcutaneous tissue. I always presumed that this was due to lymphatic invasion. Measurement of skin dose results in such variation that one should really think about the role or omission of bolus.

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Radiation Oncologist at University of Texas Health Science Center San Antonio MD Anderson Mays Cancer Center
Can you share a reference regarding recurrences mo...

Radiation Oncologist at Varian Medical Systems/Allegheny health network
Vargo and Beriwal, PMID 26383675

Radiation Oncologist at Rush University Medical Center
A request for references Langston et al. reviewed...

Radiation Oncologist at Radiation Oncology Associates PA
I'm not sure why this research wasn't highlighted ...

Radiation Oncologist at Medical University of South Carolina
Kaidar-Person et al., PMID 34563607

Radiation Oncologist at University of Texas Health Science Center San Antonio MD Anderson Mays Cancer Center
Just saw this. Thank you for sharing your referenc...

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Do you always use a bolus when treating with postmastectomy radiotherapy?

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