title: Variability in radiation oncologists' opinion on the indication of a bolus in post-mastectomy radiotherapy: an international survey.
abstract: OBJECTIVE
  Post-mastectomy radiotherapy (PMRT) decreases locoregional recurrence and increases survival for women with large tumours and/or node-positive disease. The American Society of Clinical Oncology has published treatment guidelines, but has also indicated that the optimal technique for PMRT remains unknown. The objective of this study was to evaluate the variability in which a bolus is currently used in PMRT and to identify the clinical situations in which a bolus is used.
  
  
  METHODS
  In 2004, an e-mail survey was sent to all active physician members of the American Society for Therapeutic Radiology and Oncology, the Canadian Association of Radiation Oncologists and the European Society for Therapeutic Radiology and Oncology. The survey focused on the technical details regarding the use of a bolus in PMRT.
  
  
  RESULTS
  In total, 1035 responses were obtained: 642 from the Americas (568 from the USA), 327 from Europe and 66 from Australasia. Respondents from the Americas were significantly more likely to always use a bolus (82%) than the Europeans (31%), as were the Australasians (65%) (P < 0.0001). Europeans were significantly more likely to use a bolus for specific indications (P < 0.0001). The results also showed wide variation in the schedule of application (every day [33%] and alternate days [46%]) and thickness used (< 1 cm [35%] and > or = 1 cm [48%]).
  
  
  CONCLUSIONS
  There is a wide variation in the use of a bolus in PMRT with significant regional differences. This probably translates into a variation in the dose delivered to the skin and may have an effect on local recurrence and/or toxicity. A randomised clinical trial is needed to evaluate the benefit and toxicity associated with the use of a bolus in PMRT.
authors.affiliation: Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
authors.forename: T T T
authors.initials: TT
authors.lastname: Vu
authors.forename: J P
authors.initials: JP
authors.lastname: Pignol
authors.forename: E
authors.initials: E
authors.lastname: Rakovitch
authors.forename: J
authors.initials: J
authors.lastname: Spayne
authors.forename: L
authors.initials: L
authors.lastname: Paszat
mesh_terms: D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002983:Clinical Competence; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007390:International Agencies; D008408:Mastectomy; D011182:Postoperative Care; D010818:Practice Patterns, Physicians'; D018787:Radiation Oncology / Q000592:standards* / Q000639:trends; D012867:Skin / Q000528:radiation effects*; D013909:Thorax / Q000473:pathology / Q000528:radiation effects