In Reply to Bajaj and Das

Abstract

We thank the writers for their comments about our article. 1 Bajaj A Das IJ In Regard to Nichol et al. Int J Radiat Oncol Biol Phys. 2021; 110: 1543 Abstract Full Text Full Text PDF Scopus (1) Google Scholar In our study, we excluded patients with skin involvement because we wholeheartedly agree that bolus should be prescribed for them. The writer offers intriguing thoughts about modifying radiation treatment delivery so the tissues at higher risk of recurrence within the chest wall clinical target volume receive the prescription dose and the tissues with a lower risk of recurrence are relatively spared. In addition, they correctly point out the challenges in calculating skin/surface dose and inconsistencies in clinical definitions of skin/dermal tissues, which complicate the interpretation of dosimetric studies. However, although skin dosimetry is complex, basic principles in oncology can still be applied: (1) Are any cancer cells present in the skin (in the vast majority of patients treated with modern surgery and systemic therapy, there are none), and (2) When present, do the cancer cells receive a sufficient radiation dose to eliminate them? Our pooled analysis of 7 studies showed that, among the 1093 patients treated without bolus, the crude local recurrence risk was 3.0%, indicating that 97.0% of patients either had no local cancer or had local cancer that was controlled by the radiation dose achieved without bolus.