A Case Study of Using 5 mm Bolus Every Other Day vs.

3 mm Bolus Daily in Chest Wall

Irradiation

Outline

Abstract: Left blank intentionally – to be completed later.

I. Introduction
A. Breast cancer is one of the most common forms of cancer that affects roughly 1 in
8 women. (Breast Cancer Background)1
B. There are various techniques that are effective in treating breast cancer.
(Overview of Breast Cancer Treatment Techniques)2,3
C. The use of bolus often accompanies breast cancer treatments. (The Logic Behind
Using Bolus)4,5
D. The term bolus will include: 3mm and 5mm bolus, paraffin wax and other tissue
equivalent material. (An Overview of the Various Bolus Materials)1,6,7
E. Dose distribution is affected by using bolus. (Bolus’ Effect on Dose
Distribution)5,8
F. There can be acute skin toxicity when using bolus for radiation treatments.
(Bolus’ Effect on Skin Toxicity)8,9,10,11
G. Two treatment techniques will be explored. (An Introduction to the 2
Techniques)12

1. The use of 5 mm bolus qod, meaning every other day.

2. The use of 3mm bolus qd, meaning every day.

H. There is a need to analyze the 2 bolus methods regarding skin toxicity and dose
distribution. (The Purpose for the Paper)8
II. Case Description
A. Patient Selection

1. The facilities utilized for the collection of patient data were Penrose
Cancer Center (PCC) and Kaiser Permanente Cancer Center (KP).
(Overview of Amy & Bianca’s Facilities)
 2. All patients selected for this study are previously treated patients with
varying ages and demographics. (Describe Patient’s Background)

3. Most patients are simply chest wall patients with some of them having
reconstruction. (Explain Patient’s Surgical History)2

4. Discuss how target volumes drawn by physicians. (Explain per

protocol, atlas, etc).

5. All of the patients chosen for this study were treated with a 3-field
technique of two tangents with a supraclavicular field. (Explain
Treatment Technique)
6. The tangent fields were treated with 6MV energy and a 15 MV beam
was utilized for the supraclavicular field. (Further Explain Treatment
Technique)
7. One researcher’s data focused on the use of 3mm bolus and the other
centered on 5 mm bolus. (Explain Bolus Critera; Should Lead Into
“Treatment Delineation” Section)
B. Target Delineation
1. The facilities involved in this case study utilized Pinnacle at PCC and
Eclipse planning software at KP. (Explain Treatment Planning
Software and Algorithms)
2. For each patient, the physician created a gross tumor volume (GTV)
and planned target volume (PTV). (Describe Treatment Volumes)

C. Treatment Planning
1. All patients in this study were treated using a 3-field technique of 2
tangents and a supraclavicular field. (Re-emphasize Treatment
Technique Mentioned in “Patient Selection”)
2. The treatment fields had borders that were defined through the
treatment planning process. (Describe Tangential Field Borders)
3. The borders for the supraclavicular field were different than those for
the tangential fields. (Describe Supraclavicular Field Borders)
 4. The borders used for these fields are methodically chosen by the
respective physicians. (Explain Logic of Border Selection)
5. Given the desired treatment area, there are multiple critical structures
to be cognizant of. (Describe Organs of Interest)
6. The prescription dose for these patients was relatively consistent.
(Explain the Prescription and Logic Behind It)
7. The treatment methodology utilized for these patients is relatively
standard. (Explain Gantry/Collimator Angles and the Lack of
Difference Between Patients)
8. The point of maximum dose amongst these patients was either slightly
above or below 110% of the prescribed dose. (Describe the Variation
in Hot Spots and typical accepted values in prior research)
9. Discuss acceptable maximum dose to a point. (Per protocols)
10. The information can be found in table… (Create Table Displaying
Relevant Information)
D. Plan Analysis and Evaluation
1. Explanation of Group 1. (Consists of G1-A and G1-B)
i. Comparison group for all qualifying candidates.
ii. G1-A: 3 mm Superflab qd
iii. G1-B: 5 mm Elasto-gel
2. Explanation of Group 2. (Consists of G2-A and G2-B)
i. Comparison group for candidates treated with same beam energies.
ii. G2-A: 3 mm Superflab qd
iii. G2-B: 5 mm Elasto-gel qod
3. Explanation of Group 3. (Consists of G3-A and G3-B)
i. Comparison group for candidates with the same beam energy and
classified as chest wall patients.
ii. G3-A: 3 mm Superflab qd
i. G3-B: 5 mm Elasto-gel qod
4. Explanation of Group 4. (Consists of G4-A and G4-B)
 i. Comparison group for candidates with the same beam energy and
classified as reconstruction patients.
ii. G4-A: 3 mm Superflab qd
i. G4-B: 5 mm Elasto-gel qod
5. Explanation of Group 5. (Consists of G5-A1, G5-A2 and G5-A3)
i. Comparison group for candidates who received 3 mm Superflab
bolus but different beam energies for the supraclavicular field.
ii. G5-A1: 6x/6x
iii. G5-A2: 6x/mixed beam (6x/15x)
iv. G5-A3: 6x/15x

6. Explanation of Group 6. (Consists of G6-B1, G6-B2 and G6-B3)

i. Comparison group for candidates who chemotherapy recorded as

ACT, TC and TCHP at the Penrose Cancer Center.
ii. G6-B1: ACT
iii. G6-B2: TC
iv. G6-B3: TCHP

7. Interpretation of the table information displaying results of case study.

(Explain how outcome effects future patients)

III. Conclusion
 References

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Published 2013. Accessed April 26, 2018