Cancer Care Centre, St.George Hospital, Kogarah, Sydney, NSW, Australia.
Int J Radiat Oncol Biol Phys. 2011 Nov 1;81(3):e165-71. doi: 10.1016/j.ijrobp.2011.01.002. Epub 2011 Feb 28.
Postmastectomy radiotherapy bolus is heterogenous, with little evidence to guide clinical practise. This study explores the effect of chest wall bolus technique on chest wall recurrence.
This was a retrospective cohort study of 254 patients treated with adjuvant postmastectomy radiotherapy between 1993 and 2003. Patient and treatment characteristics including bolus details were extracted. Outcomes considered were treatment toxicities, treatment delivery, and local recurrence.
In all, 143 patients received radiotherapy with whole chest wall bolus, 88 patients with parascar bolus, and 23 with no bolus. Twenty patients did not complete radiotherapy because of acute skin toxicity: 17 in the whole chest wall bolus group, 2 in the parascar bolus group, and 1 in the group not treated with bolus. On multivariate analysis, whole chest wall bolus and chemotherapy were found to be significant predictors for early cessation of radiotherapy resulting from acute skin toxicity. There were 19 chest wall failures: 13 in the whole chest wall bolus group, 4 in the parascar bolus group, and 2 in the no-bolus group. On multivariate analysis, lymphovascular invasion and failure to complete radiotherapy because of acute skin toxicity were associated with chest wall recurrence.
From our results, parascar bolus and no bolus performed no worse than did whole chest wall bolus with regard to chest wall recurrence. However, bolus may have an impact on early cessation of radiotherapy caused by skin toxicity, which then may influence chest wall recurrence.
乳腺癌根治术后放疗的填充物存在异质性，目前几乎没有证据可以指导临床实践。本研究旨在探讨胸壁填充物技术对胸壁复发的影响。
本研究回顾性分析了 1993 年至 2003 年间接受辅助性乳腺癌根治术后放疗的 254 例患者。提取患者和治疗特征，包括填充物的详细信息。主要研究终点为治疗毒性、治疗完成情况和局部复发。
共 143 例患者接受全胸壁填充物放疗，88 例患者接受部分胸壁填充物放疗，23 例患者未接受填充物放疗。由于急性皮肤毒性，20 例患者未完成放疗：全胸壁填充物放疗组 17 例，部分胸壁填充物放疗组 2 例，未接受填充物放疗组 1 例。多因素分析显示，全胸壁填充物和化疗是导致因急性皮肤毒性而提前终止放疗的显著预测因素。19 例发生胸壁复发：全胸壁填充物放疗组 13 例，部分胸壁填充物放疗组 4 例，未接受填充物放疗组 2 例。多因素分析显示，脉管侵犯和因急性皮肤毒性而无法完成放疗是胸壁复发的独立危险因素。
根据我们的研究结果，与全胸壁填充物相比，部分胸壁填充物和不使用填充物在胸壁复发方面并未表现出劣势。然而，填充物可能会对皮肤毒性引起的早期放疗终止产生影响，进而影响胸壁复发。
