Abstract

BackgroundThe optimal chest wall bolus regimen for postmastectomy radiotherapy (PMRT) remains unknown. We aimed to prospectively evaluate the use of a 1-mm-thick daily tissue-equivalent bolus in patients who received PMRT using thermoluminescent dosimeters (TLDs) and skin toxicity assessment.MethodsPatients with a 1-mm-thick daily bolus during PMRT were prospectively enrolled at The Juntendo University Hospital. The surface dose was measured in vivo under the 1-mm-thick bolus on the chest wall. We assessed the acute skin toxicity weekly during PMRT, and 1, 2, 4, and 12 weeks after the completion of PMRT.ResultsA total of 19 patients aged 32–79 years old received PMRT from July 2019 to January 2020. All patients completed the protocol treatment without interruptions, and the median follow-up was 32 weeks. In vivo dosimetry analysis revealed surface doses between 77 and 113% of the prescribed dose, with a mean of 92% of the prescribed radiation dose, and a standard deviation of 7% being delivered. Grade 2 dermatitis was found in 10 patients (53%), and Grade 3 dermatitis was found in one patient (5%). All cases of Grade 2 and 3 dermatitis were improved 4 weeks after PMRT. There were no cases of Grade 4 dermatitis and no chest wall recurrences during the treatment or follow-up period.ConclusionsResults confirmed the feasibility of using a 1-mm-thick daily bolus for PMRT, exhibiting an appropriate dose buildup and acceptable skin toxicity without treatment interruptions.Trial registrationThe University Hospital Medical Information Network Clinical Trials Registry, UMIN000035773. Registered 1 July 2019.

Highlights

  • The optimal chest wall bolus regimen for postmastectomy radiotherapy (PMRT) remains unknown

  • We report the results of skin toxicity associated with PMRT using a 1-mm-thick daily bolus, as well as the skin dose using thermoluminescent dosimeters (TLDs; Toyo Medic Co., Ltd.; Tokyo, JP)

  • Patient selection Patients (i) with pathologically confirmed breast cancer; (ii) requiring PMRT; (iii) aged 20 years and older; (iv) with an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0–2; and (v) with no history of prior overlapping radiation were eligible for the study

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Summary

Introduction

The optimal chest wall bolus regimen for postmastectomy radiotherapy (PMRT) remains unknown. We aimed to prospectively evaluate the use of a 1-mm-thick daily tissue-equivalent bolus in patients who received PMRT using thermoluminescent dosimeters (TLDs) and skin toxicity assessment. Postmastectomy radiotherapy (PMRT) has proven useful for increasing both locoregional control and overall survival among patients with high-risk breast cancer [1–4]. There are currently various options regarding the bolus regimen and bolus material for PMRT. We report the results of skin toxicity associated with PMRT using a 1-mm-thick daily bolus, as well as the skin dose using thermoluminescent dosimeters (TLDs; Toyo Medic Co., Ltd.; Tokyo, JP)

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