Bolus Use in Postmastectomy Radiation Therapy for Breast Cancer: A Systematic Literature Review

IntroductionTissue-equivalent boluses are used to increase the skin surface dose in patients with breast cancer undergoing postmastectomy radiotherapy. Boluses made from various materials have been developed and applied in clinical practice. However, there is currently no international standardization for their use. This study aimed to analyze the advantages and disadvantages of using compensatory membranes (boluses), identify the optimal patient population for their postoperative application, and determine the most suitable types of compensatory membranes for use in postoperative radiotherapy for breast cancer.MethodsThis study includes a systematic literature review of sources such as websites, books, and articles from January 2013 to December 2023. We analyzed and compared studies on the use of compensatory membranes in postoperative radiotherapy for breast cancer, evaluating differences among various bolus materials as well as the impact of using no bolus. Outcomes such as patient responses and prognosis were also assessed. After excluding abstracts, reviews, and other non-research articles, a total of 32 studies were included in the analysis.Results3D-printed boluses and brass mesh boluses show promise as alternatives to traditional bolus materials, with potential for broader clinical application. The use of a bolus can increase the incidence of acute radiation-induced toxicities, without significant improvements in long-term patient prognosis. For patients receiving chest wall radiotherapy after breast cancer surgery, bolus use may be considered selectively, especially in those with high-risk factors.ConclusionCurrently, there is no unified standard for bolus use in breast cancer patients undergoing chest wall radiotherapy following modified radical mastectomy. This review provides a critical evaluation of existing literature, summarizing the available bolus materials and their influence on radiotherapy outcomes in postoperative breast cancer treatment.