Department of Radiation Oncology, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Radiology, Juntendo University Hospital, Tokyo, Japan.
BMC Cancer. 2021 Feb 2;21(1):109. doi: 10.1186/s12885-021-07851-3.
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.
Patients 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.
A 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.
Results 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.
The University Hospital Medical Information Network Clinical Trials Registry, UMIN000035773 . Registered 1 July 2019.
乳腺癌根治术后放疗（PMRT）的最佳胸壁填充物方案仍不清楚。我们旨在使用热释光剂量计（TLD）和皮肤毒性评估前瞻性评估在 PMRT 中使用 1 毫米厚的每日组织等效填充物的患者。
在 Juntendo 大学医院前瞻性招募了在 PMRT 中使用 1 毫米厚的每日 bolus 的患者。在胸壁的 1 毫米厚 bolus 下进行体内表面剂量测量。我们在 PMRT 期间每周评估急性皮肤毒性，并在 PMRT 完成后 1、2、4 和 12 周评估。
共有 19 名 32-79 岁的患者在 2019 年 7 月至 2020 年 1 月期间接受 PMRT。所有患者均无中断地完成了方案治疗，中位随访时间为 32 周。体内剂量学分析显示，表面剂量在处方剂量的 77%至 113%之间，平均为 92%的处方剂量，标准偏差为 7%。10 名患者（53%）出现 2 级皮炎，1 名患者（5%）出现 3 级皮炎。所有 2 级和 3 级皮炎均在 PMRT 后 4 周改善。在治疗或随访期间无 4 级皮炎和胸壁复发。
结果证实了在 PMRT 中使用 1 毫米厚的每日 bolus 的可行性，表现出适当的剂量堆积和可接受的皮肤毒性，没有治疗中断。
大学医院医疗信息网临床试验注册处，UMIN000035773。2019 年 7 月 1 日注册。
