Das Lauren C, Golden Daniel W, Perevalova Eugenia, Wong Anthony C, De Nardo Kimberly, Stepaniak Christopher, Joyce Daniel S, McCabe Bradley P, Hasan Yasmin, Chmura Steven J, McCall Anne
Department of Radiation and Cellular Oncology, The University of Chicago Medical Center, Chicago, Illinois.
Department of Radiation and Cellular Oncology, The University of Chicago Comprehensive Cancer Center at Silver Cross, New Lenox, Illinois.
Pract Radiat Oncol. 2017 May-Jun;7(3):161-166. doi: 10.1016/j.prro.2016.10.015. Epub 2016 Oct 24.
The purpose of this study was to prospectively evaluate the use of daily 2-mm bolus in patients undergoing postmastectomy radiation without reconstruction using optically stimulated luminescence dosimetry and weekly assessment of skin toxicity.
We prospectively collected data from the first 49 women treated with a daily 2-mm Superflab bolus during their postmastectomy radiation therapy from 2013 to 2016 at The University of Chicago Comprehensive Cancer Center at Silver Cross. Within the first 3 days of starting radiation therapy, we measured the surface dose in vivo at 5 anatomical locations under the 2-mm bolus on the chest wall. We assessed weekly the acute skin toxicity during radiation using the National Cancer Institute Common Toxicity Criteria. Patients with reconstruction before radiation therapy were excluded.
Forty-nine women with a mean age of 54.3 years were treated with daily 2-mm bolus to the chest wall following mastectomy. Median follow-up was 32.7 weeks. The mean percentages of prescribed dose (standard deviation) for the median, central, lateral, superior, and inferior optically stimulated luminescence dosimeters were 100.1% (5.6%), 108.1% (6.7%), 98.1% (6.5%), 102.6% (8.9%), and 106.3% (6.6%), respectively. The majority (71.4%) of women experienced a maximum acute National Cancer Institute Common Toxicity Criteria skin toxicity score of 2, with only 12.2% experiencing a score of 3. There were no grade 4 toxicities. There were no local recurrences during our follow-up period.
A daily 2-mm bolus is a feasible regimen for chest wall bolus during postmastectomy radiation therapy with acceptable dose buildup and skin toxicity.
本研究的目的是前瞻性评估在未进行乳房重建的乳房切除术后放疗患者中每日使用2毫米厚组织等效物 bolus 的情况，采用光激发发光剂量测定法以及每周评估皮肤毒性。
我们前瞻性收集了2013年至2016年在芝加哥大学综合癌症中心银十字分院接受乳房切除术后放疗的前49名女性的数据，她们在放疗期间每日使用2毫米厚的 Superflab bolus。在开始放疗的前3天内，我们在胸壁上2毫米厚组织等效物 bolus 下方的5个解剖位置测量了体内表面剂量。我们使用美国国立癌症研究所通用毒性标准每周评估放疗期间的急性皮肤毒性。排除放疗前进行过乳房重建的患者。
49名平均年龄为54.3岁的女性在乳房切除术后接受了每日2毫米厚组织等效物 bolus 的胸壁放疗。中位随访时间为32.7周。中位、中央、外侧、上方和下方光激发发光剂量计的处方剂量平均百分比（标准差）分别为100.1%（5.6%）、108.1%（6.7%）、98.1%（6.5%）、102.6%（8.9%）和106.3%（6.6%）。大多数（71.4%）女性的美国国立癌症研究所通用毒性标准皮肤毒性最高评分为2，只有12.2%的女性评分为3。没有4级毒性反应。在我们的随访期间没有局部复发。
每日使用2毫米厚组织等效物 bolus 是乳房切除术后放疗期间胸壁 bolus 的一种可行方案，剂量增加和皮肤毒性均可接受。
