The Value of 3D Printed Bolus in Adjuvant Intensity-modulated Radiotherapy After Radical Mastectomy for Breast Cancer--A Prospective Cohort Study
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Purpose Breast cancer patients may use a bolus to increase the dose of skin in radiotherapy after radical mastectomy. The 3D printed bolus (3DPB) made by individual customization has better fit and conformance. This study aims to provide some reference value for the treatment by analyzing the dosage advantages of 3DPB in radiotherapy after radical mastectomy of breast cancer. Materials and Methods The study included breast cancer patients who received post-mastectomy radiotherapy with 3DPB between January 1, 2022 and April 30, 2023. Researchers retrospectively collected dosage data related to patients' radiotherapy plans, prospectively observed acute and late radiotherapy side-effects in patients of this cohort. Matched sample T-test was used for data conforming to normal distribution, and non-parametric test was used for data not conforming to normal distribution. P<0.05 was considered statistically significant. Results A total of 35 patients were included in this cohort and median follow-up time was 16 months. In the side-effects of radiotherapy, no level 4 acute side-effects occurred. A total of 82.2% of the patients had no obvious side-effects, and 2.7% had a level 3 acute skin side-effects. Level 3 leukocytes, platelets, and erythrocytes decreased in 5.7%, 2.9%, and 2.9%, respectively. No late radiotherapy side-effects of level 2 or higher occurred. In terms of dosage, radiotherapy plans using 3DPB had better conformance (P<0. 001) and dose homogeneity (P<0. 001). The results showed that the V95% dose was higher for the CTV1, CTV2, P-CTV, P-CTV1, and P-CTV2 that covered the 3DPB (all P< 0. 001). Conclusions Overall, the use of 3DPB in radiotherapy of breast cancer is safe and feasible, with low incidence of acute and late side-effects. At the same time, the use of 3DPB can make the dose distribution higher and more uniform, while obtaining a more conformal target area.
