Iranian Journal of Medical Physics

Iranian Journal of Medical Physics

Effect of Bolus Frequency and Its Thickness in Postmastectomy Three-dimensional Conformal Radiotherapy on Skin Dose for Superposition Algorithm

Document Type : Original Paper

Authors
Karim BAHHOUS 1
Mustapha ZERFAOUI 2
Naima EL KHAYATI 1
1 ESMaR, Faculty of Science, Mohammed V University in Rabat, Rabat, Morocco
2 LPMR, Faculty of Science, University Mohamed 1st, Oujda, Morocco
10.22038/ijmp.2018.33900.1426
Abstract
Introduction: The postmastectomy radiotherapy uses bolus to improve the coverage close to the skin; however, it needs to be removed in case of severe skin toxicity. This study investigated the effect of bolus parameters (i.e., frequency and thickness) for the superposition algorithm on skin dose in postmastectomy three-dimensional conformal radiotherapy (3D-CRT).
Material and Methods: The present study was carried out ona total of 22 patients. First, all the plans were calculated without using bolus. Then, the plans were recalculated using different bolus frequencies (5, 10, 15, 20, 25) and thicknesses (0.5 and 1 cm). To evaluate the dose delivered to the skin, a 2-mm thick skin was profiled, and statistical analysis was performed by studying the dosimetric parameters (i.e., minimum, mean, and maximum) of chest wall skin.
Results: The superficial coverage of planning target volume (PTV) was better by using bolus. In the case of skin, the bolus thickness had a significant impact on the minimum and mean doses for all bolus frequencies , while there was no significant effect on the maximum before 20-bolus frequency. The bolus frequency increase demonstrated a significant difference on all dosimetric parameters of the skin , except the maximum showed no significant difference between 0 and 5-bolus frequencies .
Conclusion: The obtained results indicated that the bolus use had generally a significant effect on the chest wall skin dosimetric parameters depending on bolus frequency and thickness. Therefore, the choice of bolus frequency and bolus thickness can affect the clinical decisions in certain cases.
Keywords
Bolus
Postmastectomy
Chest Wall
Skin Dose
Superposition
Conformal Radiotherapy
Subjects
  1. Nakamura N, Arahira S, Zenda S, Yoneyama K, Mukai H, Onozawa M, et al. Post-mastectomy radiation therapy without usage of a bolus may be a reasonable option. Journal of radiation research. 2017 Jan 1;58(1):66-70.
  2. Healy E, Anderson S, Cui J, Beckett L, Chen AM, Perks J, et al. Skin dose effects of postmastectomy chest wall radiation therapy using brass mesh as an alternative to tissue equivalent bolus. Practical radiation oncology. 2013 Apr 1;3(2):45-53.
  3. Ordonez-Sanz C, Bowles S, Hirst A, MacDougall ND. A single plan solution to chest wall radiotherapy with bolus?.The British journal of radiology. 2014 Mar 18;87(1037):20140035.
  4. Tieu MT, Graham P, Browne L, Chin YS. The effect of adjuvant postmastectomy radiotherapy bolus technique on local recurrence. International Journal of Radiation Oncology* Biology* Physics. 2011 Nov 1;81(3):165-71.
  5. Recht A, Comen EA, Fine RE, Fleming GF, Hardenbergh PH, Ho AY, et al. Postmastectomy radiotherapy: an american society of clinical oncology, american society for radiation oncology, and society of surgical oncology focused guideline update. Annals of surgical oncology. 2017 Jan 1;24(1):38-51.
  6. Vu TT, Pignol JP, Rakovitch E, Spayne J, Paszat L. Variability in radiation oncologists' opinion on the indication of a bolus in post-mastectomy radiotherapy: an international survey. Clinical Oncology. 2007 Mar 1;19(2):115-9.
  7. Jo IY, Kim SW, Son SH. Dosimetric evaluation of the skin-sparing effects of 3-dimensional conformal radiotherapy and intensity-modulated radiotherapy for left breast cancer. Oncotarget. 2017 Jan 10;8(2):3059.
  8. Miften MM, Beavis AW, Marks LB. Influence of dose calculation model on treatment plan evaluation in conformal radiotherapy: a three-case study. Medical Dosimetry. 2002 Mar 1;27(1):51-7.
  9. Papanikolaou N, Battista JJ, Boyer AL, Kappas C, Klein E, Mackie TR, et al. Tissue inhomogeneity corrections for megavoltage photon beams. AAPM Task Group. 2004 Aug; 65:1-42.
  10. Mesbahi A, Zergoug I. Dose calculations for lung inhomogeneity in high-energy photon beams and small beamlets: a comparison between XiO and TiGRT treatment planning systems and MCNPX Monte Carlo code. Iranian Journal of Medical Physics. 2015;12(3):167-77.
  11. O'connor JE. The variation of scattered x-rays with density in an irradiated body. Physics in Medicine & Biology. 1957 Apr;1(4):352.
  12. Horst KC, Kovalchuk N, Marquez C. Postmastectomy Radiotherapy with and Without Reconstruction, in Radiation Therapy Techniques and Treatment Planning for Breast Cancer. Practical Guides in Radiation Oncology. Springer, Cham. 2016; 17–27.
  13. International Commission on Radiation Units and Measurements (ICRU50). Prescribing, Recording, and Reporting Photon Beam Therapy. Available from:http://www.icru.org/home/reports/prescribing-recording-and-reporting-photon-beam-therapy-report-50.
  14. White J, Tai A, Arthur D, Buchholz T, MacDonald Sh, Marks L, et al. Breast Cancer Atlas for Radiation Therapy Planning: Consensus Definitions. 2018. Available from: Https://www.rtog.org/LinkClick.aspx?fileticket=vzJFhPaBipE%3d&tabid=236.
  15. Andic F, Ors Y, Davutoglu R, Cifci SB, Ispir EB, Erturk ME. Evaluation of skin dose associated with different frequencies of bolus applications in post-mastectomy three-dimensional conformal radiotherapy. Journal of Experimental & Clinical Cancer Research. 2009 Dec;28(1):41.
  16. Ma C, Zhang W, Lu J, Wu L, Wu F, Huang B, et al. Dosimetric comparison and evaluation of three radiotherapy techniques for use after modified radical mastectomy for locally advanced left-sided breast cancer. Scientific reports. 2015 Jul 21;5: 12274.
  17. Fischbach M, Hälg RA, Hartmann M, Besserer J, Gruber G, Schneider U. Measurement of skin and target dose in post-mastectomy radiotherapy using 4 and 6 MV photon beams. Radiation Oncology. 2013 Dec;8(1):270.
  18. Shaw E, Kline R, Gillin M, Souhami L, Hirschfeld A, Dinapoli R, et al. Radiation Therapy Oncology Group: radiosurgery quality assurance guidelines. International Journal of Radiation Oncology* Biology* Physics. 1993 Dec 1;27(5):1231-9.
  19. Lomax NJ, Scheib SG. Quantifying the degree of conformity in radiosurgery treatment planning. International Journal of Radiation Oncology* Biology* Physics. 2003 Apr 1;55(5):1409-19.
  20. Sroka M, Reguła J, Łobodziec W. The influence of the bolus-surface distance on the dose distribution in the build-up region. Reports of Practical Oncology & Radiotherapy. 2010 Nov 1;15(6):161-4.
  21. Petti PL, Goodman MS, Sisterson JM, Biggs PJ, Gabriel TA, Mohan R. Sources of electron contamination for the Clinac‐35 25‐MV photon beam. Medical physics. 1983 Nov;10(6):856-61.
  22. Yadav G, Yadav RS, Kumar A. Effect of various physical parameters on surface and build-up dose for 15-MV X-rays. Journal of Medical Physics/Association of Medical Physicists of India. 2010 Oct;35(4):202. 

 

 

 

Iranian Journal of Medical Physics
Volume 16, Issue 6 - Serial Number 6
November and December 2019
Pages 397-404

  • Receive Date 18 September 2018
  • Revise Date 17 November 2018
  • Accept Date 04 December 2018