title: The effect of adjuvant postmastectomy radiotherapy bolus technique on local recurrence.
abstract: OBJECTIVE
  Postmastectomy radiotherapy bolus is heterogenous, with little evidence to guide clinical practise. This study explores the effect of chest wall bolus technique on chest wall recurrence.
  
  
  METHODS
  This was a retrospective cohort study of 254 patients treated with adjuvant postmastectomy radiotherapy between 1993 and 2003. Patient and treatment characteristics including bolus details were extracted. Outcomes considered were treatment toxicities, treatment delivery, and local recurrence.
  
  
  RESULTS
  In all, 143 patients received radiotherapy with whole chest wall bolus, 88 patients with parascar bolus, and 23 with no bolus. Twenty patients did not complete radiotherapy because of acute skin toxicity: 17 in the whole chest wall bolus group, 2 in the parascar bolus group, and 1 in the group not treated with bolus. On multivariate analysis, whole chest wall bolus and chemotherapy were found to be significant predictors for early cessation of radiotherapy resulting from acute skin toxicity. There were 19 chest wall failures: 13 in the whole chest wall bolus group, 4 in the parascar bolus group, and 2 in the no-bolus group. On multivariate analysis, lymphovascular invasion and failure to complete radiotherapy because of acute skin toxicity were associated with chest wall recurrence.
  
  
  CONCLUSIONS
  From our results, parascar bolus and no bolus performed no worse than did whole chest wall bolus with regard to chest wall recurrence. However, bolus may have an impact on early cessation of radiotherapy caused by skin toxicity, which then may influence chest wall recurrence.
authors.affiliation: Cancer Care Centre, St.George Hospital, Kogarah, Sydney, NSW, Australia.
authors.forename: Minh Thi
authors.initials: MT
authors.lastname: Tieu
authors.forename: Peter
authors.initials: P
authors.lastname: Graham
authors.forename: Lois
authors.initials: L
authors.lastname: Browne
authors.forename: Yaw Sinn
authors.initials: YS
authors.lastname: Chin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002921:Cicatrix / Q000532:radiotherapy; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D008408:Mastectomy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy*; D011855:Radiodermatitis / Q000209:etiology; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D035441:Thoracic Wall / Q000528:radiation effects*