AUTHOR=Wang Xiran , Zhao Jianling , Xiang Zhongzheng , Wang Xuetao , Zeng Yuanyuan , Luo Ting , Yan Xi , Zhang Zhuang , Wang Feng , Liu Lei 

TITLE=3D-printed bolus ensures the precise postmastectomy chest wall radiation therapy for breast cancer

JOURNAL=Frontiers in Oncology

VOLUME=12

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.964455

DOI=10.3389/fonc.2022.964455

ISSN=2234-943X

ABSTRACT=<sec><title>Purpose</title><p>To investigate the values of a 3D-printed bolus ensuring the precise postmastectomy chest wall radiation therapy for breast cancer.</p></sec><sec><title>Methods and materials</title><p>In the preclinical study on the anthropomorphic phantom, the 3D-printed bolus was used for dosimetry and fitness evaluation. The dosimetric parameters of planning target volume (PTV) were assessed, including D<sub>min</sub>, D<sub>max</sub>, D<sub>mean</sub>, D<sub>95%</sub>, homogeneity index (HI), conformity index (CI), and organs at risk (OARs). The absolute percentage differences (|%diff|) between the theory and fact skin dose were also estimated, and the follow-up was conducted for potential skin side effects.</p></sec><sec><title>Results</title><p>In preclinical studies, a 3D-printed bolus can better ensure the radiation coverage of PTV (HI 0.05, CI 99.91%), the dose accuracy (|%diff| 0.99%), and skin fitness (mean air gap 1.01 mm). Of the 27 eligible patients, we evaluated the radiation dose parameter (median(min–max): D<sub>min</sub> 4967(4789–5099) cGy, D<sub>max</sub> 5447(5369–5589) cGy, D<sub>mean</sub> 5236(5171–5323) cGy, D<sub>95%</sub> 5053(4936–5156) cGy, HI 0.07 (0.06–0.17), and CI 99.94% (97.41%–100%)) and assessed the dose of OARs (ipsilateral lung: D<sub>mean</sub> 1341(1208–1385) cGy, V<sub>5</sub> 48.06%(39.75%–48.97%), V<sub>20</sub> 24.55%(21.58%–26.93%), V<sub>30</sub> 18.40%(15.96%–19.16%); heart: D<sub>mean</sub> 339(138–640) cGy, V<sub>30</sub> 1.10%(0%–6.14%), V<sub>40</sub> 0.38%(0%–4.39%); spinal cord PRV: D<sub>max</sub> 639(389–898) cGy). The skin doses <italic>in vivo</italic> were D<sub>theory</sub> 208.85(203.16–212.53) cGy, D<sub>fact</sub> 209.53(204.14–214.42) cGy, and |%diff| 1.77% (0.89–2.94%). Of the 360 patients enrolled in the skin side effect follow-up study (including the above 27 patients), grade 1 was the most common toxicity (321, 89.2%), some of which progressing to grade 2 or grade 3 (32, 8.9% or 7, 1.9%); the radiotherapy interruption rate was 1.1%.</p></sec><sec><title>Conclusion</title><p>A 3D-printed bolus can guarantee the precise radiation dose on skin surface, good fitness to skin, and controllable acute skin toxicity, which possesses a great clinical application value in postmastectomy chest call radiation therapy for breast cancer.</p></sec>