Li Xing, Bhagroo Stephen, Su Fan-Chi, Rahimi Robabeh, Tward Jonathan
Department of Advanced Radiation Oncology and Proton Therapy, Inova Schar Cancer Institute, Fairfax, Virginia, USA.
Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA.
J Appl Clin Med Phys. 2025 Jul;26(7):e70175. doi: 10.1002/acm2.70175.
Traditional boluses for pelvic lesions present challenges, including compromised skin dose coverage from large air gaps in treatment plans and increased uncertainties in treatment delivery due to variations in bolus fitting. This study evaluates the clinical benefits of a patient-specific, 3D-printed bolus (pBolus) in external beam radiation therapy (EBRT) for extramammary Paget's disease in the inguinal fold. A three-dimensional (3D) conformal plan utilizing the pBolus was compared to a conventional Superflab bolus (sBolus) under identical beam arrangements. The pBolus improved dose conformity by reducing air gaps in the treatment plan, and therefore, it was selected for clinical treatment. Weekly setup imaging revealed air gaps predominantly along the inguinal fold, demonstrating overall consistency in bolus fitting with minor air gap variations. Additionally, in vivo dosimetry confirmed dose accuracy. As a result, the patient achieved a favorable outcome, with no clinical evidence of disease at the follow-up visit.
用于盆腔病变的传统填充物存在挑战，包括治疗计划中因大空气间隙导致皮肤剂量覆盖不足，以及由于填充物适配差异导致治疗实施的不确定性增加。本研究评估了个体化3D打印填充物（pBolus）在腹股沟褶部乳腺外佩吉特病的外照射放疗（EBRT）中的临床益处。在相同的射束布置下，将使用pBolus的三维（3D）适形计划与传统的Superflab填充物（sBolus）进行比较。pBolus通过减少治疗计划中的空气间隙改善了剂量适形性，因此被选择用于临床治疗。每周的摆位成像显示空气间隙主要沿腹股沟褶部，表明填充物适配总体一致，空气间隙变化较小。此外，体内剂量测定证实了剂量准确性。结果，该患者取得了良好的疗效，随访时无疾病的临床证据。
