The use of bolus in postmastectomy radiation therapy for breast cancer: A systematic review

Crit Rev Oncol Hematol. 2021 Jul:163:103391. doi: 10.1016/j.critrevonc.2021.103391. Epub 2021 Jun 5.

Abstract

Purpose: Post mastectomy radiation therapy (PMRT) reduces locoregional recurrence (LRR) and breast cancer mortality for selected patients. Bolus overcomes the skin-sparing effect of external-beam radiotherapy, ensuring adequate dose to superficial regions at risk of local recurrence (LR). This systematic review summarizes the current evidence regarding the impact of bolus on LR and acute toxicity in the setting of PMRT.

Results: 27 studies were included. The use of bolus led to higher rates of acute grade 3 radiation dermatitis (pooled rates of 9.6% with bolus vs. 1.2% without). Pooled crude LR rates from thirteen studies (n = 3756) were similar with (3.5%) and without (3.6%) bolus.

Conclusions: Bolus may be indicated in cases with a high risk of LR in the skin, but seems not to be necessary for all patients. Further work is needed to define the role of bolus in PMRT.

Keywords: PMRT; bolus; breast cancer; mastectomy; post-mastectomy; radiation therapy; tissue compensator.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Breast Neoplasms* / pathology
  • Breast Neoplasms* / radiotherapy
  • Breast Neoplasms* / surgery
  • Female
  • Humans
  • Mastectomy
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Staging
  • Radiodermatitis*
  • Radiotherapy, Adjuvant / adverse effects