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      Effectiveness of the use of chest wall bolus during adjuvant intensity modulated radiotherapy after modified radical mastectomy

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          Abstract

          Objective To analyze the recurrence of breast cancer without use of chest wall bolus during adjuvant intensity modulated radiotherapy after modified radical mastectomy, so as to investigate the necessity of bolus use.

          Methods A total of 218 patients undergoing adjuvant intensity modulated radiotherapy after modified radical mastectomy during the period from January 2013 to June 2019 were enrolled as the study subjects. The chest wall bolus was not used during the whole period of radiotherapy after modified radical mastectomy, and the recurrence of breast cancer in the chest wall was analyzed after radiotherapy.

          Results The post-surgical follow-up through outpatient records, inpatients records, local residents’ health system and telephone was performed until June 31, 2021. The proportion of follow-up was 100%, and the mean follow-up period was 48.9 months. There were three cases with breast cancer recurrence in the chest wall, including one case with recurrence in the chest wall alone and two cases with recurrence in the chest wall and regional lymph nodes, and the overall recurrence of breast cancer was 1.4% in the chest wall. Among the 3 cases with breast cancer recurrence in the chest wall, there were two cases with N3 stage and positive for HER2, and one triple-negative breast cancer case, and all three cases developed distal metastases upon local recurrence. Among 218 study subjects, there were 5 cases with grade I radioactive skin reaction, 3 cases with grade II radioactive skin reaction, and no grade III or IV radioactive skin reaction occurred. In addition, no grade III or IV acute radioactive injury was seen in the chest wall skin among the 218 study subjects.

          Conclusion No use of chest wall bolus may be considered during adjuvant intensity modulated radiotherapy after modified radical mastectomy in presence of systemic therapy if tumor invasion into skin is not observed prior to therapy.

          Abstract

          摘要: 目的 分析乳腺癌改良根治术后辅助调强放疗中胸壁未放置补偿膜的复发率, 探讨补偿膜放置的必要性。 方法 以2013年1月一2019年6月收治的218例乳腺癌改良根治术后辅助调强放疗病例为研宄对象, 术后放疗全程 胸壁未放置补偿膜, 分析放疗后胸壁复发率。 结果 住院记录、门诊记录、本市居民健康系统、电话等方式随访至 2021年6月31日, 随访率100%, 平均随访时间48.9个月。放疗后出现胸壁复发为3例, 其中1例单纯胸壁复发、2例合并区域淋巴结复发, 胸壁复发率为1.4%。3例出现胸壁复发的乳腺癌患者中, 其中2例患者TNM分期为N3、HER2阳性, 1例患者为三阴性, 3例患者出现局部复发时均伴有远处转移。218例患者中, 5例出现I度放射性皮肤反 应, 3例出现II度放射性皮肤反应, 未出现III度或IV度放射性皮肤反应; 218例病例胸壁皮肤均未出现III/IV度急性放 射性损伤。 结论 乳腺癌改良根治术后辅助适型/调强放射治疗, 在系统的全身治疗情况下, 如果治疗前肿瘤没有侵犯 皮肤, 胸壁放疗时可考虑不放置补偿膜。

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          Author and article information

          Journal
          CJRH
          Chinese Journal of Radiological Health
          Chinese Preventive Medical Association (Ji’an, China )
          1004-714X
          01 August 2022
          01 December 2022
          : 31
          : 4
          : 494-497
          Affiliations
          [1] 1Department of Radiotherapy, Zhongshan Hospital Affiliated to Xiamen University, Xiamen 361004 China
          Article
          j.issn.1004-714X.2022.04.021
          10.13491/j.issn.1004-714X.2022.04.021
          2bbe7db9-2441-4b5f-adb5-4ee455fc007e
          © 2022 Chinese Journal of Radiological Health

          This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

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          Categories
          Journal Article

          Medicine,Image processing,Radiology & Imaging,Bioinformatics & Computational biology,Health & Social care,Public health
          Breast cancer,Local recurrence,Bolus,Intensity modulated radiotherapy

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