Do you routinely use bolus for treatment of early stage glottic cancer?  

Our group routinely uses IMRT to treat early glottic cancers, with the object of reducing carotid and skin toxicity.  As such, we treat the entire larynx with a 5 mm PTV expansion and see good coverage of the anterior commissure in general.  We do not add bolus routinely.  This might ...

If you are using IMRT and you feel comfortable with the PTV coverage anteriorly, no need to use bolus. If you are not using IMRT, and there is anterior commissure involvement and/or a very thin patient, then I would add 5mm bolus anteriorly with a flash on the lateral beams.

No.  However if on pre-treatment imaging or CT simulation imaging there is less than 5 mm of soft tissue from the anterior commissure to the skin, will place bolus.  Usually 3 mm is sufficient. Important to review the isodose lines to ensure proper coverage of the anterior commissure in a...