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Flail Chest-I01:24

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Overview of Flail Chest
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
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Related Experiment Video

Updated: Feb 12, 2026

Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy
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Outcomes in Patients Treated with Post-mastectomy Chest Wall Radiotherapy without the Routine Use of Bolus.

M L Yap1, M Tieu1, J Sappiatzer1

  • 1Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.

Clinical Oncology (Royal College of Radiologists (Great Britain))
|March 28, 2018
PubMed
Summary

Selective use of bolus in post-mastectomy radiotherapy (PMRT) did not increase chest wall recurrence in low-risk patients. Routine bolus use in PMRT may be unnecessary, with lower toxicity observed in non-bolus groups.

Keywords:
Bolusbreast canceroutcomespost-mastectomy radiotherapyradiotherapy

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Area of Science:

  • Oncology
  • Radiotherapy
  • Breast Cancer Treatment

Background:

  • The application of bolus in post-mastectomy radiotherapy (PMRT) is inconsistent across medical institutions.
  • Understanding the impact of selective bolus use on outcomes is crucial for optimizing PMRT protocols.

Purpose of the Study:

  • To evaluate the rates of chest wall recurrence and acute toxicity in post-mastectomy radiotherapy patients treated with selective bolus application.
  • To determine if the routine use of bolus in PMRT is necessary for all patients.

Main Methods:

  • Analysis of 314 post-mastectomy radiotherapy patients treated between 2004 and 2009.
  • Chest wall bolus was selectively used for patients identified as high-risk for local recurrence.
  • Prospective data collection supplemented by retrospective review of radiotherapy details and acute toxicity.

Main Results:

  • The 4-year chest wall recurrence rate was 14% in the bolus group versus 3.5% in the non-bolus group (P=0.025), though significance was lost when considering margin status.
  • Selective bolus use was associated with a higher rate of acute grade 2 skin toxicity (40% vs. 21%, P=0.01).
  • No significant increase in chest wall recurrence was observed in low-risk patients receiving selective bolus.

Conclusions:

  • Selective bolus use in PMRT appears safe for low-risk patients regarding chest wall recurrence.
  • The findings suggest that routine bolus application in PMRT may not be universally required.
  • Optimizing bolus strategy could potentially reduce acute toxicity without compromising local control.